Healthcare Provider Details

I. General information

NPI: 1154552867
Provider Name (Legal Business Name): RICHARD KEIJZER M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S ACC 300
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

1600 7TH AVE S ACC 300
BIRMINGHAM AL
35233-1711
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-9688
  • Fax: 205-975-4972
Mailing address:
  • Phone: 205-939-9688
  • Fax: 205-975-4972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberL.3030R
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: