Provider Demographics
NPI:1487767216
Name:KINNEBREW, TERRY V (MD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:V
Last Name:KINNEBREW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2696
Mailing Address - Country:US
Mailing Address - Phone:205-631-5521
Mailing Address - Fax:205-631-5540
Practice Address - Street 1:758 MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2696
Practice Address - Country:US
Practice Address - Phone:205-631-5521
Practice Address - Fax:205-631-5540
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12977207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009942565Medicaid
AL051519411Medicare ID - Type Unspecified
AL009942565Medicaid