Healthcare Provider Details

I. General information

NPI: 1528004348
Provider Name (Legal Business Name): BRUCE CAMPBELL MCFADDEN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 HIGHWAY 78 E
JASPER AL
35501-8956
US

IV. Provider business mailing address

1200 CORPORATE DR SUITE 230
BIRMINGHAM AL
35242-2941
US

V. Phone/Fax

Practice location:
  • Phone: 205-387-4187
  • Fax: 205-387-4727
Mailing address:
  • Phone: 205-995-7980
  • Fax: 205-995-7985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-41
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: