Healthcare Provider Details

I. General information

NPI: 1578548244
Provider Name (Legal Business Name): JOHN P CIMINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47344 US HIGHWAY 78
LINCOLN AL
35096-6748
US

IV. Provider business mailing address

1130 22ND ST S STE 1000
BIRMINGHAM AL
35205-2881
US

V. Phone/Fax

Practice location:
  • Phone: 256-763-7848
  • Fax: 256-763-7235
Mailing address:
  • Phone: 205-715-5198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number23304
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: