Healthcare Provider Details

I. General information

NPI: 1558577452
Provider Name (Legal Business Name): JASON EMERY KINZEL JASON KINZEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 LOWELL DR SE STE 204
HUNTSVILLE AL
35801-3754
US

IV. Provider business mailing address

420 LOWELL DR SE STE 204
HUNTSVILLE AL
35801-3754
US

V. Phone/Fax

Practice location:
  • Phone: 256-536-9031
  • Fax: 256-539-4240
Mailing address:
  • Phone: 256-536-9031
  • Fax: 256-539-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number225426
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD32456
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: