Healthcare Provider Details

I. General information

NPI: 1932125101
Provider Name (Legal Business Name): CAESAR JOHN CORTOPASSI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5295 PRESERVE PARKWAY SUITE 100
HOOVER AL
35244
US

IV. Provider business mailing address

5295 PRESERVE PARKWAY SUITE 100
HOOVER AL
35244
US

V. Phone/Fax

Practice location:
  • Phone: 205-987-4444
  • Fax: 205-987-4451
Mailing address:
  • Phone: 205-987-4444
  • Fax: 205-987-4451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8529
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier51510842
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerBLUE CROSS OF ALABAMA
# 2
Identifier000026582
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer
# 3
Identifier009910995
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer
# 4
Identifier51026582
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerBLUE CROSS OF ALABAMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: