Provider Demographics
NPI:1811257926
Name:FAIRHOPE UROLOGY, PC
Entity type:Organization
Organization Name:FAIRHOPE UROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:PETRUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-990-2241
Mailing Address - Street 1:8720 FAIRHOPE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3608
Mailing Address - Country:US
Mailing Address - Phone:251-990-2241
Mailing Address - Fax:251-990-2242
Practice Address - Street 1:8720 FAIRHOPE AVE
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3608
Practice Address - Country:US
Practice Address - Phone:251-990-2241
Practice Address - Fax:251-990-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29300208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty