Healthcare Provider Details

I. General information

NPI: 1285900597
Provider Name (Legal Business Name): BRIAN PAUL FLETCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2129 HELTON DR
FLORENCE AL
35630
US

IV. Provider business mailing address

PO BOX 10005
FLORENCE AL
35631-2005
US

V. Phone/Fax

Practice location:
  • Phone: 256-764-2482
  • Fax: 256-764-2982
Mailing address:
  • Phone: 256-764-2482
  • Fax: 256-764-2982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number38269
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: