Healthcare Provider Details

I. General information

NPI: 1700048998
Provider Name (Legal Business Name): BARRY L. FIELDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SOUTHLAKE PKWY
BIRMINGHAM AL
35244-3202
US

IV. Provider business mailing address

4700 SOUTHLAKE PKWY
BIRMINGHAM AL
35244-3202
US

V. Phone/Fax

Practice location:
  • Phone: 205-733-1306
  • Fax:
Mailing address:
  • Phone: 205-733-1306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number16905
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number16905
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: