Basic Information
| Provider Information | |||||||||
| NPI: | 1295702678 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIKE | ||||||||
| FirstName: | BOB | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2147 RIVERCHASE OFFICE RD | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352441836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2054038902 | ||||||||
| FaxNumber: | 2054212121 | ||||||||
| Practice Location | |||||||||
| Address1: | 9772 PARKWAY E | ||||||||
| Address2: | AMERICAN FAMILY CARE, INC. | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352157804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058336888 | ||||||||
| FaxNumber: | 2058368399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2006 | ||||||||
| LastUpdateDate: | 09/18/2012 | ||||||||
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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 | 207Q00000X | 11136 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080185459 | 01 | AL | RAILROAD MEDICARE | OTHER | 000008371 | 05 | AL | MEDICAID | 051008374 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER |