Healthcare Provider Details

I. General information

NPI: 1629050752
Provider Name (Legal Business Name): ROBERT M PRITCHETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 10TH AVE S STE 400
BIRMINGHAM AL
35205-1200
US

IV. Provider business mailing address

2700 10TH AVE S STE 400
BIRMINGHAM AL
35205-1200
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-7710
  • Fax: 205-933-8685
Mailing address:
  • Phone: 205-933-7710
  • Fax: 205-933-8685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number7094
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number7094
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number7094
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: