Healthcare Provider Details

I. General information

NPI: 1699904441
Provider Name (Legal Business Name): ALABAMA MED & SURGICAL FOOT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 GADSDEN HIGHWAY SUITE 120
BIRMINGHAM AL
35235
US

IV. Provider business mailing address

1960 GADSDEN HIGHWAY SUITE 120
BIRMINGHAM AL
35235
US

V. Phone/Fax

Practice location:
  • Phone: 205-655-1114
  • Fax: 205-661-3585
Mailing address:
  • Phone: 205-655-1114
  • Fax: 205-661-3585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number228
License Number StateAL

VIII. Authorized Official

Name: KEVIN L WALDROP
Title or Position: OWNER
Credential: DPM
Phone: 205-655-1114