Healthcare Provider Details

I. General information

NPI: 1962590117
Provider Name (Legal Business Name): LENA I BEDRI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 JACK WARNER PKWY NE SUITE K
TUSCALOOSA AL
35404-5751
US

IV. Provider business mailing address

535 JACK WARNER PKWY NE SUITE K
TUSCALOOSA AL
35404-5751
US

V. Phone/Fax

Practice location:
  • Phone: 205-758-6471
  • Fax: 205-758-6472
Mailing address:
  • Phone: 205-758-6471
  • Fax: 205-758-6472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number00026345
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number00026345
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: