Provider Demographics
NPI:1710080734
Name:SUBLETT, KEVIN LEONARD (MDFACC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LEONARD
Last Name:SUBLETT
Suffix:
Gender:M
Credentials:MDFACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3368 HIGHWAY 280
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-3393
Mailing Address - Country:US
Mailing Address - Phone:256-234-2644
Mailing Address - Fax:256-234-2704
Practice Address - Street 1:3368 HIGHWAY 280
Practice Address - Street 2:SUITE 130
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3393
Practice Address - Country:US
Practice Address - Phone:256-234-2644
Practice Address - Fax:256-234-2704
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00015380207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009903660Medicaid
AL009903660Medicaid
AL51007980SUBMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER