Healthcare Provider Details

I. General information

NPI: 1962498295
Provider Name (Legal Business Name): MARION L SENNETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEMORIAL HOSPITAL DR STE 3A
MOBILE AL
36608-1183
US

IV. Provider business mailing address

100 MEMORIAL HOSPITAL DR STE 3A
MOBILE AL
36608-1183
US

V. Phone/Fax

Practice location:
  • Phone: 251-342-2641
  • Fax: 251-343-9507
Mailing address:
  • Phone: 251-342-2641
  • Fax: 251-343-9507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number00010417
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: