Healthcare Provider Details

I. General information

NPI: 1013092253
Provider Name (Legal Business Name): MARK A ISAACS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CARRAWAY BLVD
BIRMINGHAM AL
35234-1913
US

IV. Provider business mailing address

PO BOX 830469 MSC 511
BIRMINGHAM AL
35283-0469
US

V. Phone/Fax

Practice location:
  • Phone: 205-502-6000
  • Fax: 205-502-5720
Mailing address:
  • Phone: 205-979-5882
  • Fax: 205-979-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-074501
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: