Healthcare Provider Details

I. General information

NPI: 1407037955
Provider Name (Legal Business Name): RONALD DAVID AGEE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 BESSEMER RD
BIRMINGHAM AL
35208-4016
US

IV. Provider business mailing address

1529 BESSEMER RD
BIRMINGHAM AL
35208-4016
US

V. Phone/Fax

Practice location:
  • Phone: 205-925-5272
  • Fax: 205-929-0170
Mailing address:
  • Phone: 205-925-5272
  • Fax: 205-929-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number103
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number103
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number103
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number103
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: