Healthcare Provider Details

I. General information

NPI: 1952606311
Provider Name (Legal Business Name): JOSEPH D SMITHERMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 01/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 19TH ST S ROOM - JT845
BIRMINGHAM AL
35249-1900
US

IV. Provider business mailing address

PO BOX 11407 DEPARTMENT 1717
BIRMINGHAM AL
35246-1717
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-7072
  • Fax: 205-975-1248
Mailing address:
  • Phone: 205-934-7072
  • Fax: 205-975-5963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-102737
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: