Basic Information
| Provider Information | |||||||||
| NPI: | 1477516037 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REAL | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 130693 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352130693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058771930 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2010 BROOKWOOD MEDICAL CTR DR | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352096804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058771930 | ||||||||
| FaxNumber: | 2058772400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 10/16/2015 | ||||||||
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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 | 207P00000X | 00012138 | AL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 051518363 | 01 | AL | BLUE CROSS/BLUE SHIELD | OTHER | 051518363 | 05 | AL | MEDICAID |