Healthcare Provider Details

I. General information

NPI: 1902008063
Provider Name (Legal Business Name): BAY PODIATRY, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5253 HIGHWAY 90 W SUITE L
MOBILE AL
36619-4228
US

IV. Provider business mailing address

30723A EMBER LN
SPANISH FORT AL
36527-5105
US

V. Phone/Fax

Practice location:
  • Phone: 251-661-8200
  • Fax:
Mailing address:
  • Phone: 251-621-8699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number238
License Number StateAL

VIII. Authorized Official

Name: ROBERT E JOHNSON
Title or Position: MANAGER
Credential:
Phone: 251-621-8699