Healthcare Provider Details

I. General information

NPI: 1730389867
Provider Name (Legal Business Name): MOBILE REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6332 PICCADILLY SQUARE DR
MOBILE AL
36609-5143
US

IV. Provider business mailing address

6332 PICCADILLY SQUARE DR
MOBILE AL
36609-5143
US

V. Phone/Fax

Practice location:
  • Phone: 251-461-9914
  • Fax:
Mailing address:
  • Phone: 251-461-9914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number12943
License Number StateAL

VIII. Authorized Official

Name: DR. SHANNON M GILMORE
Title or Position: PRESIDENT
Credential: MD
Phone: 251-461-9914