Healthcare Provider Details

I. General information

NPI: 1164542346
Provider Name (Legal Business Name): JEFFREY D FAGGARD M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 SPRING HILL AVE SUITE 100
MOBILE AL
36604-1407
US

IV. Provider business mailing address

1700 SPRING HILL AVE SUITE 100
MOBILE AL
36604-1407
US

V. Phone/Fax

Practice location:
  • Phone: 251-435-1200
  • Fax: 251-435-6357
Mailing address:
  • Phone: 251-435-1200
  • Fax: 251-435-6357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25661
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: