Provider Demographics
NPI:1740283548
Name:BOROUGHS, ALBERT R IV (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:R
Last Name:BOROUGHS
Suffix:IV
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 1:75 HIGHWAY 136 W
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36460
Mailing Address - Country:US
Mailing Address - Phone:251-575-4825
Mailing Address - Fax:251-575-7730
Practice Address - Street 1:75 HIGHWAY 136 W
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460
Practice Address - Country:US
Practice Address - Phone:251-575-4825
Practice Address - Fax:251-575-7730
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00022765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL02327OtherBCBS PROVIDER #
AL009958120Medicaid
AL080173663OtherRR MEDICARE PROVIDER #
AL02327OtherBCBS PROVIDER #
AL051502327Medicare ID - Type UnspecifiedPROVIDER #