Healthcare Provider Details

I. General information

NPI: 1023319563
Provider Name (Legal Business Name): ROBERT J SCIACCA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 SOUTHLAKE PKWY STE 300
BIRMINGHAM AL
35244-3317
US

IV. Provider business mailing address

4515 SOUTHLAKE PKWY STE 300
BIRMINGHAM AL
35244-3317
US

V. Phone/Fax

Practice location:
  • Phone: 205-985-7393
  • Fax: 205-987-1332
Mailing address:
  • Phone: 205-985-7393
  • Fax: 205-987-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number8954
License Number StateAL

VIII. Authorized Official

Name: MRS. LATARA D POLLARD
Title or Position: OFFICE MANAGER
Credential:
Phone: 205-985-7393