Basic Information
| Provider Information | |||||||||
| NPI: | 1962481218 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESTOPINAL | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | TEMPLE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2006 FRANKLIN ST SE | ||||||||
| Address2: | STE 301 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565399471 | ||||||||
| FaxNumber: | 2565399472 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 SIVLEY RD SW | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562651000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 00022267 | AL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 51050650 | 01 | AL | BCBS - HH LOCATIONS | OTHER | 51523667 | 01 | AL | BCBS - MASC LOCATION | OTHER | 4013861 | 01 | TN | BCBS TN | OTHER |