Healthcare Provider Details

I. General information

NPI: 1518161504
Provider Name (Legal Business Name): REBECCA ANNE MOUL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 HIGHWAY 280 STE 200
BIRMINGHAM AL
35242-5186
US

IV. Provider business mailing address

4600 HIGHWAY 280 STE 200
BIRMINGHAM AL
35242-5186
US

V. Phone/Fax

Practice location:
  • Phone: 205-971-5000
  • Fax: 205-971-5050
Mailing address:
  • Phone: 205-971-5000
  • Fax: 205-971-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDO1154
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: