Healthcare Provider Details

I. General information

NPI: 1922011527
Provider Name (Legal Business Name): BEVERLY ANN VONDER POOL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 02/01/2024
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2152 OLD SPRINGVILLE RD
BIRMINGHAM AL
35215-4005
US

IV. Provider business mailing address

2152 OLD SPRINGVILLE RD
BIRMINGHAM AL
35215-4005
US

V. Phone/Fax

Practice location:
  • Phone: 205-838-6000
  • Fax: 205-838-6078
Mailing address:
  • Phone: 205-838-6000
  • Fax: 205-838-6078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16895
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: