Healthcare Provider Details

I. General information

NPI: 1275875627
Provider Name (Legal Business Name): EVAN DANE SMOTHERS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 HIGHWAY 280
BIRMINGHAM AL
35242-5185
US

IV. Provider business mailing address

1 W LAKESHORE DR STE 100
BIRMINGHAM AL
35209-7271
US

V. Phone/Fax

Practice location:
  • Phone: 205-408-1231
  • Fax: 205-481-1229
Mailing address:
  • Phone: 205-547-3996
  • Fax: 205-408-9931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1626
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: