Basic Information
Provider Information | |||||||||
NPI: | 1447227046 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ROMAN | ||||||||
FirstName: | DEBORAH | ||||||||
MiddleName: | THIGPEN | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | PETERS | ||||||||
OtherFirstName: | DEBORAH | ||||||||
OtherMiddleName: | T | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 830810 | ||||||||
Address2: | MSC 10000020 | ||||||||
City: | BIRMINGHAM | ||||||||
State: | AL | ||||||||
PostalCode: | 352830810 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2054038902 | ||||||||
FaxNumber: | 2054212121 | ||||||||
Practice Location | |||||||||
Address1: | 9772 PARKWAY E | ||||||||
Address2: | AMERICAN FAMILY CARE INC | ||||||||
City: | BIRMINGHAM | ||||||||
State: | AL | ||||||||
PostalCode: | 35215 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2058336888 | ||||||||
FaxNumber: | 2058368399 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/02/2006 | ||||||||
LastUpdateDate: | 09/20/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 12073 | AL | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 080021652 | 01 | AL | RAILROAD MEDICARE | OTHER | 009949035 | 05 | AL |   | MEDICAID | 83403 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER |