Healthcare Provider Details

I. General information

NPI: 1669456851
Provider Name (Legal Business Name): JEREMY CLARK BARLOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MONTGOMERY HWY STE 200
VESTAVIA HILLS AL
35216-1896
US

IV. Provider business mailing address

PO BOX 530604
BIRMINGHAM AL
35253-0604
US

V. Phone/Fax

Practice location:
  • Phone: 205-723-0088
  • Fax: 205-406-7222
Mailing address:
  • Phone: 205-879-8294
  • Fax: 205-879-8259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number19621
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number19621
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: