1144228388 NPI number — LEONARD TERRY PYNES MD

Table of content: LEONARD TERRY PYNES MD (NPI 1144228388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144228388 NPI number — LEONARD TERRY PYNES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PYNES
Provider First Name:
LEONARD
Provider Middle Name:
TERRY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PYNES
Provider Other First Name:
L
Provider Other Middle Name:
TERRY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1144228388
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/16/2006
NPI Reactivation Date:
03/23/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2431 W MAIN ST
Provider Second Line Business Mailing Address:
STE 501
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36301-1274
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-793-9222
Provider Business Mailing Address Fax Number:
334-671-0322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2431 W MAIN ST
Provider Second Line Business Practice Location Address:
STE 501
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-793-9222
Provider Business Practice Location Address Fax Number:
334-671-0322
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  8834 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 8834 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000081148 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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