Healthcare Provider Details

I. General information

NPI: 1598199317
Provider Name (Legal Business Name): JONATHAN PAUL CAVANAGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

1940 ELMER J BISSELL RD
BIRMINGHAM AL
35243-2941
US

V. Phone/Fax

Practice location:
  • Phone: 205-638-4949
  • Fax: 205-638-4982
Mailing address:
  • Phone: 205-638-4949
  • Fax: 205-638-4982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberL.3851F
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: