Healthcare Provider Details

I. General information

NPI: 1174674907
Provider Name (Legal Business Name): DARRELL ZIROLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 POWERS CIR
MOUNT OLIVE AL
35117-3243
US

IV. Provider business mailing address

695 POWERS CIR
MOUNT OLIVE AL
35117-3243
US

V. Phone/Fax

Practice location:
  • Phone: 205-631-5657
  • Fax:
Mailing address:
  • Phone: 205-631-5657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA60
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: