Healthcare Provider Details

I. General information

NPI: 1467529495
Provider Name (Legal Business Name): JEFFREY H. FADIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 CO RD 133
ABBEVILLE AL
36310
US

IV. Provider business mailing address

1833 CO RD 133
ABBEVILLE AL
36310
US

V. Phone/Fax

Practice location:
  • Phone: 251-295-2815
  • Fax:
Mailing address:
  • Phone: 251-295-2815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29664
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: