Provider Demographics
NPI:1851346183
Name:RIZK, BOTROS M (MD)
Entity Type:Individual
Prefix:
First Name:BOTROS
Middle Name:M
Last Name:RIZK
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:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-415-1496
Mailing Address - Fax:251-415-1450
Practice Address - Street 1:1601 CENTER ST
Practice Address - Street 2:STE 3S
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1512
Practice Address - Country:US
Practice Address - Phone:251-415-1496
Practice Address - Fax:251-415-1450
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18303207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51023885OtherBLUE CROSS
LA1502804Medicaid
MS00115713Medicaid
AL74-10529OtherUNITED HEALTH CARE
AL000023885Medicaid
AL000023885Medicaid
AL160056040Medicare ID - Type UnspecifiedRAILROAD PGBA
MS00115713Medicaid