Provider Demographics
NPI:1033108436
Name:RADER, DAVID L (MD P C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:RADER
Suffix:
Gender:M
Credentials:MD P C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3746 E FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35213-4214
Mailing Address - Country:US
Mailing Address - Phone:054-474-7112
Mailing Address - Fax:
Practice Address - Street 1:3746 E FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35213-4214
Practice Address - Country:US
Practice Address - Phone:205-447-4711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2023-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11987208600000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL84730OtherBLUE CROSS PROVIDER
ALC70956OtherUPIN
AL000084730Medicare PIN