Healthcare Provider Details

I. General information

NPI: 1134286131
Provider Name (Legal Business Name): PEDIATRIC PARTNERS OF MOBILE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 UNIVERSITY BLVD S
MOBILE AL
36609-2960
US

IV. Provider business mailing address

1605 UNIVERSITY BLVD S
MOBILE AL
36609-2960
US

V. Phone/Fax

Practice location:
  • Phone: 251-660-9393
  • Fax: 251-662-0372
Mailing address:
  • Phone: 251-660-9393
  • Fax: 251-662-0372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateAL

VIII. Authorized Official

Name: DWIGHT A YODER
Title or Position: OWNER
Credential: MD, FAAP
Phone: 251-660-9393