Healthcare Provider Details

I. General information

NPI: 1023549292
Provider Name (Legal Business Name): O'GORMAN VEIN & VASCULAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 HILLCREST RD
MOBILE AL
36695-3909
US

IV. Provider business mailing address

861 HILLCRET RD
MOBILE AL
36685-0819
US

V. Phone/Fax

Practice location:
  • Phone: 251-410-8346
  • Fax: 251-410-8347
Mailing address:
  • Phone: 251-410-8346
  • Fax: 251-410-8347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number13943
License Number StateAL

VIII. Authorized Official

Name: KAREN C FREEMAN
Title or Position: PHYSICIAN COORDINATOR
Credential: COORDINATOR
Phone: 251-414-5900