Basic Information
| Provider Information | |||||||||
| NPI: | 1174743223 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEDSOLE | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | LAWRENCE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7987 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366700987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516330573 | ||||||||
| FaxNumber: | 2516337367 | ||||||||
| Practice Location | |||||||||
| Address1: | 5955 AIRPORT BLVD | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516330573 | ||||||||
| FaxNumber: | 2516337367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2007 | ||||||||
| LastUpdateDate: | 06/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 24341 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | 24341 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RC0200X | 24341 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 512-05486 | 01 | AL | BCBS | OTHER | 114384 | 05 | AL | MEDICAID | 3927512 | 01 | AL | CIGNA HC | OTHER | 9142095 | 01 | AL | AETNA | OTHER | 212339 | 05 | AL | MEDICAID | 221311 | 05 | AL | MEDICAID | 512-05487 | 01 | AL | BCBS | OTHER | 515-42476 | 01 | AL | BCBS | OTHER | 102I293604 | 01 | AL | MEDICARE | OTHER | 212885 | 05 | AL | MEDICAID | 2213591 | 01 | AL | UHC | OTHER | H64421 | 01 | AL | VIVA HEALTH | OTHER | 04383264 | 01 | MS | MS MEDICAID | OTHER | 221440 | 05 | AL | MEDICAID | P01098579 | 01 | AL | RR MEDICARE | OTHER |