Basic Information
| Provider Information | |||||||||
| NPI: | 1003901240 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALABAMA PEDIATRIC GASTROENTEROLOGY, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2151 HIGHLAND AVE S | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352054079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059335744 | ||||||||
| FaxNumber: | 2059336666 | ||||||||
| Practice Location | |||||||||
| Address1: | 2151 HIGHLAND AVE S | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352054079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059335744 | ||||||||
| FaxNumber: | 2059336666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 09/11/2007 | ||||||||
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| AuthorizedOfficialLastName: | CAVENDAR | ||||||||
| AuthorizedOfficialFirstName: | CARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2059335744 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0206X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology |
No ID Information.