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NPI Code Detail

MEDICARE: B.L. CARDEN, MD,LLC

MEDICARE: B.L. CARDEN, MD,LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DA7204OTHERALRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00069193OTHERALRAILROAD PIN
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134136732
Entity Type Code : Organization
Provider Name (Legal Business Name) : B.L. CARDEN, MD,LLC
Provider Business Mailing Address
First Line : 1810 STADIUM DR
Second Line :
City : PHENIX CITY
State : AL
Zip : 36867-3177
Country : US
Telephone Number : 334-448-1899
Fax Number :
Provider Business Practice Location Address
First Line : 1810 STADIUM DR
Second Line : SUITE 220
City : PHENIX CITY
State : AL
Zip : 36867-3100
Country : US
Telephone Number : 334-664-0210
Fax Number :
Authorized Official
Title or Position : OWNER
Name : BRADLEY LAMAR CARDEN
Credential : MD
Telephone Number : 334-664-0210
Provider Enumeration Date : 08/03/2006
Last Update Date : 02/18/2010

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