Healthcare Provider Details

I. General information

NPI: 1114979838
Provider Name (Legal Business Name): DALTON ANTHONY BEDSOLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MEDICAL PARK DR E SUITE 350
BIRMINGHAM AL
35235-3400
US

IV. Provider business mailing address

48 MEDICAL PARK DR E SUITE 350
BIRMINGHAM AL
35235-3400
US

V. Phone/Fax

Practice location:
  • Phone: 205-838-3040
  • Fax:
Mailing address:
  • Phone: 205-838-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4264
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: