Healthcare Provider Details

I. General information

NPI: 1528119781
Provider Name (Legal Business Name): SOUTHSIDE ENDOCRINOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CRESTWOOD BLVD STE 201
IRONDALE AL
35210-2051
US

IV. Provider business mailing address

1900 CRESTWOOD BLVD STE 201
IRONDALE AL
35210-2051
US

V. Phone/Fax

Practice location:
  • Phone: 205-957-0034
  • Fax: 205-957-0036
Mailing address:
  • Phone: 205-957-0034
  • Fax: 205-957-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number9301
License Number StateAL

VIII. Authorized Official

Name: DR. DAVID SAMUEL HENRY BELL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 205-957-0034