Healthcare Provider Details

I. General information

NPI: 1720602170
Provider Name (Legal Business Name): ROSEMARY STOWE MOAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 PROVIDENCE PARK
BIRMINGHAM AL
35242-4680
US

IV. Provider business mailing address

2001 PROVIDENCE PARK
BIRMINGHAM AL
35242-4680
US

V. Phone/Fax

Practice location:
  • Phone: 205-982-7220
  • Fax: 205-407-4072
Mailing address:
  • Phone: 205-982-7220
  • Fax: 205-407-4072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number49157
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLL84223
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: