Healthcare Provider Details

I. General information

NPI: 1780468108
Provider Name (Legal Business Name): FBL PHYSICIANS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 MOBILE INFIRMARY BLVD
MOBILE AL
36607-3509
US

IV. Provider business mailing address

171 MOBILE INFIRMARY BLVD
MOBILE AL
36607-3509
US

V. Phone/Fax

Practice location:
  • Phone: 251-300-9223
  • Fax:
Mailing address:
  • Phone: 251-300-9223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARON BUSH-COAXUM
Title or Position: PARTNER
Credential: MD
Phone: 251-300-9223