Basic Information
Provider Information
NPI: 1235327503
EntityType: 2
ReplacementNPI:  
OrganizationName: WETUMPKA HOSPITALISTS, P.C.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2257 TAYLOR RD
Address2: SUITE 200
City: MONTGOMERY
State: AL
PostalCode: 361177790
CountryCode: US
TelephoneNumber: 3342709174
FaxNumber: 3342703195
Practice Location
Address1: 74186 TALLASSEE HWY
Address2:  
City: WETUMPKA
State: AL
PostalCode: 360925643
CountryCode: US
TelephoneNumber: 3343150420
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/11/2007
LastUpdateDate: 05/12/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: DEJESUS
AuthorizedOfficialFirstName: RONALDO
AuthorizedOfficialMiddleName: V.
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 3343150420
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


Home