Healthcare Provider Details

I. General information

NPI: 1538148291
Provider Name (Legal Business Name): JAMES PAUL BERETTA M.D., D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 MEADOWVIEW LANE SUITE 101
PELHAM AL
35124
US

IV. Provider business mailing address

2501 MEADOWVIEW LANE SUITE 101
PELHAM AL
35124
US

V. Phone/Fax

Practice location:
  • Phone: 205-685-5357
  • Fax: 205-685-5371
Mailing address:
  • Phone: 205-685-5357
  • Fax: 205-685-5371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0289
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberD0289
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: