Healthcare Provider Details

I. General information

NPI: 1659310126
Provider Name (Legal Business Name): ZACK R. CHAPMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2890 DAUPHIN ST
MOBILE AL
36606-2457
US

IV. Provider business mailing address

PO BOX 55059
BIRMINGHAM AL
35255-5059
US

V. Phone/Fax

Practice location:
  • Phone: 251-473-2020
  • Fax: 251-479-6737
Mailing address:
  • Phone: 205-322-3332
  • Fax: 205-322-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-033469
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: