Provider Demographics
NPI:1760541635
Name:DAVID L. RADER, M.D.P.C.
Entity Type:Organization
Organization Name:DAVID L. RADER, M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:RADER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-933-8150
Mailing Address - Street 1:833 SAINT VINCENTS DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1606
Mailing Address - Country:US
Mailing Address - Phone:205-933-8150
Mailing Address - Fax:205-558-4064
Practice Address - Street 1:833 SAINT VINCENTS DR
Practice Address - Street 2:SUITE 202
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1606
Practice Address - Country:US
Practice Address - Phone:205-933-8150
Practice Address - Fax:205-558-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11987208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51084730OtherPROVIDER NUMBER
ALC70956Medicare UPIN