Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 00020616 | AL |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 00020616 | AL |
NPI | 1487727764 |
---|---|
Provider Name | John Randall Riehl |
First Address | Decatur, AL 35601-3595 |
Second Address | Decatur, AL 35601-3595 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 22/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51030115 | BLUECROSS BLUESHIELD AL (01) | AL |
G49125 | (02) |