Healthcare Provider Details

I. General information

NPI: 1033228242
Provider Name (Legal Business Name): GRAYSON K RODGERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 10TH AVE S STE 502
BIRMINGHAM AL
35205-1250
US

IV. Provider business mailing address

2700 10TH AVE S STE 502
BIRMINGHAM AL
35205-1250
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-2951
  • Fax: 205-933-5893
Mailing address:
  • Phone: 205-933-2951
  • Fax: 205-933-5893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number00016561
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: