Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 4772 | AL |
Y | 213EG0000X | General Practice | 4772 | AL |
NPI | 1003800046 |
---|---|
Provider Name | Dr. Sam J Citrano JR. |
First Address | Huntsville, AL 35801-4142 |
Second Address | Huntsville, AL 35801-4142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2005 |
Last Update Date | 08/07/2007 |