Lakeshore Pediatrics of Russellville
NPI #1194907394 in Russellville, Alabama
Provider Information
- NPI Number
- 1194907394
- Entity Type
- Organization
- Organization Name
- Lakeshore Pediatrics of Russellville
- Primary Specialty
- Pediatrics
- Enumeration Date
- Nov 29, 2007
- Last Updated
- Nov 29, 2007
Practice Location
- Address
- 603 GANDY ST NE
- City
- Russellville
- State
- Alabama
- ZIP Code
- 35653-1911
- Phone
- (256) 331-5055
Authorized Official
- Name
- DR. AGUSTIN RIVAS, M.D.
- Title
- OWNER
- Phone
- (256) 386-4151
Specialties & Taxonomy Codes
| Specialty |
|---|
| Pediatrics |
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