Healthcare Provider Details

I. General information

NPI: 1922001643
Provider Name (Legal Business Name): BRIAN KEITH ERGLE AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CAHABA VALLEY PKWY SUITE 200
PELHAM AL
35124-2216
US

IV. Provider business mailing address

245 CAHABA VALLEY PKWY SUITE 200
PELHAM AL
35124-2216
US

V. Phone/Fax

Practice location:
  • Phone: 800-379-0309
  • Fax: 205-942-5627
Mailing address:
  • Phone: 800-379-0309
  • Fax: 205-942-5627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number51486
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number5652
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA2835
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number817A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: