Healthcare Provider Details

I. General information

NPI: 1053807388
Provider Name (Legal Business Name): OSWALDO ANTONIO GOMEZ QUEVEDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S # JFL300
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

1600 7TH AVE S # JFL300
BIRMINGHAM AL
35233-1711
US

V. Phone/Fax

Practice location:
  • Phone: 205-638-9688
  • Fax: 205-975-4972
Mailing address:
  • Phone: 205-638-9688
  • Fax: 205-975-4972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberL.5391F
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number13830
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: