Healthcare Provider Details

I. General information

NPI: 1205495520
Provider Name (Legal Business Name): JOSE MANUEL ACEVEDO ECHEVARRIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 UNIVERSITY HOSPITAL DR RM 714
MOBILE AL
36617-2300
US

IV. Provider business mailing address

2451 UNIVERSITY HOSPITAL DR RM 714
MOBILE AL
36617-2300
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-7117
  • Fax:
Mailing address:
  • Phone: 251-471-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46739
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number46739
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: