Provider Demographics
NPI:1700855467
Name:FAMBROUGH, RAY A (MD)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:A
Last Name:FAMBROUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801
Mailing Address - Country:US
Mailing Address - Phone:256-534-2728
Mailing Address - Fax:256-428-3423
Practice Address - Street 1:927 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-534-2728
Practice Address - Fax:256-428-3423
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6835207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4003535OtherAETNA
AL0910134OtherUNITED HEALTHCARE
AL200038949OtherRAILROAD MEDICARE
AL51008835OtherBCBS
AL000008835Medicaid
C75359Medicare UPIN
AL4003535OtherAETNA