Provider Demographics
NPI:1851357933
Name:POORE, RAYMOND E JR (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:E
Last Name:POORE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 AFFLINK PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2289
Mailing Address - Country:US
Mailing Address - Phone:205-366-9740
Mailing Address - Fax:205-344-9992
Practice Address - Street 1:1780 MCFARLAND BLVD N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2136
Practice Address - Country:US
Practice Address - Phone:205-345-7351
Practice Address - Fax:205-345-8476
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL20891208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-68253OtherBCBS OF AL
AL114258Medicaid
AL114261Medicaid
AL511-00713OtherBCBS OF AL
AL114264Medicaid
AL510-68237OtherBCBS OF AL
AL510-68270OtherBCBS OF AL
AL114255Medicaid
AL20891OtherMEDICAL LICENSE
AL510-68253OtherBCBS OF AL
AL114261Medicaid