Healthcare Provider Details

I. General information

NPI: 1275517377
Provider Name (Legal Business Name): WILLARD ROGER CARLISLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 INDEPENDENCE PLZ SUITE 900
BIRMINGHAM AL
35209-2629
US

IV. Provider business mailing address

1 INDEPENDENCE PLZ SUITE 900
BIRMINGHAM AL
35209-2629
US

V. Phone/Fax

Practice location:
  • Phone: 205-271-8000
  • Fax: 205-879-0548
Mailing address:
  • Phone: 205-271-8000
  • Fax: 205-879-0548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number7258
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: