Healthcare Provider Details

I. General information

NPI: 1649367228
Provider Name (Legal Business Name): DIEGMANN AND HENDERSON OBGYN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL PARK
FAIRHOPE AL
36532-1804
US

IV. Provider business mailing address

2 MEDICAL PARK
FAIRHOPE AL
36532-1804
US

V. Phone/Fax

Practice location:
  • Phone: 251-990-6550
  • Fax: 251-990-6552
Mailing address:
  • Phone: 251-990-6550
  • Fax: 251-990-6552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number000001748
License Number StateAL

VIII. Authorized Official

Name: BRET HENDERSON
Title or Position: PRESIDENT
Credential: MD
Phone: 251-521-8394