Healthcare Provider Details

I. General information

NPI: 1437899010
Provider Name (Legal Business Name): EPHRAIM REYES CAANGAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 MEDICAL CENTER PKWY STE 200
SELMA AL
36701-7739
US

IV. Provider business mailing address

625 19TH ST S
BIRMINGHAM AL
35233-1900
US

V. Phone/Fax

Practice location:
  • Phone: 334-334-8754
  • Fax:
Mailing address:
  • Phone: 334-875-4184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number51792
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: