Basic Information
| Provider Information | |||||||||
| NPI: | 1497786958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOSE | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 7TH AVE S | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352331711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056389587 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1600 7TH AVE S | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352331711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056389100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 02/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD.17705 | AL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208000000X | MD.17705 | AL | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0204X | MD.17705 | AL | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine | 207SG0201X | 17705 | AL | Y | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) |
ID Information
| ID | Type | State | Issuer | Description | 009935375 | 05 | AL | MEDICAID | 051020867 | 01 | AL | BLUE CROSS | OTHER | 051535390 | 01 | AL | BLUE CROSS | OTHER | 9938841 | 05 | AL | MEDICAID | 009938834 | 05 | AL | MEDICAID | 009953715 | 05 | AL | MEDICAID | 051535484 | 01 | AL | BLUE CROSS | OTHER | 051535501 | 01 | AL | BLUE CROSS | OTHER | 051535504 | 01 | AL | BLUE CROSS | OTHER | 125385 | 05 | AL | MEDICAID | 148176 | 05 | AL | MEDICAID | 051535486 | 01 | AL | BLUE CROSS | OTHER | 051535668 | 01 | AL | BLUE CROSS | OTHER | 09922541 | 05 | MS | MEDICAID | 009938844 | 05 | AL | MEDICAID | 051520541 | 01 | AL | BLUE CROSS | OTHER | 051547020 | 01 | AL | BLUE CROSS | OTHER | 105120 | 05 | AL | MEDICAID | 511-30868 | 01 | AL | BCBS | OTHER | 9938838 | 05 | AL | MEDICAID | 051113380 | 01 | AL | BLUE CROSS | OTHER | 051590996 | 01 | AL | BLUE CROSS | OTHER | 105106 | 05 | AL | MEDICAID | 051535507 | 01 | AL | BLUE CROSS | OTHER | 051535671 | 01 | AL | BLUE CROSS | OTHER | 051594923 | 01 | AL | BLUE CROSS | OTHER | 009938832 | 05 | AL | MEDICAID | 009938833 | 05 | AL | MEDICAID | 051106841 | 01 | AL | BLUE CROSS | OTHER | 009938839 | 05 | AL | MEDICAID | 009938842 | 05 | AL | MEDICAID | 009938843 | 05 | AL | MEDICAID | 051535487 | 01 | AL | BLUE CROSS | OTHER | 051543551 | 01 | AL | BLUE CROSS | OTHER | 142698 | 05 | AL | MEDICAID | 511-36079 | 01 | AL | BCBS | OTHER |