Basic Information
| Provider Information | |||||||||
| NPI: | 1932593548 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCABE | ||||||||
| FirstName: | FULLER | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 PAUL W BRYANT DR E | ||||||||
| Address2: | |||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354012055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053450192 | ||||||||
| FaxNumber: | 2057598784 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 PAUL W BRYANT DR E | ||||||||
| Address2: | |||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354012055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0523450192 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2015 | ||||||||
| LastUpdateDate: | 08/30/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 27163 | MS | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 282N00000X | N | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 266786 | 05 | AL | MEDICAID |