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General NPI Number Information
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NPI Number | 1427143015
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Entity Type | Individual
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Provider Name | BRIAN JEFFERY WIATRAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/24/2014
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Provider Practice Location Address
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Address Line | 1940 ELMER J. BISSELL ROAD PEDIATRIC ENT ASSOCIATES
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City | BIRMINGHAM
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State | AL
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Zip | 35243
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Country | US
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Telephone | 205-638-4949
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Fax | 205-638-4983
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Provider Business Mailing Address
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Address Line | 4931 COLD HARBOR DRIVE
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City | BIRMINGHAM
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State | AL
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Zip | 35223
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Country | US
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Telephone | 205-951-5488
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number | 17153
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License Number State | AL
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