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General NPI Number Information
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NPI Number | 1598073868
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Entity Type | Organization
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Legal Business Name | BLUE BAYOU SERVICES GROUP INC
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 09/20/2010
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Provider Practice Location Address
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Address Line | 2214 3RD AVE N
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City | BIRMINGHAM
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State | AL
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Zip | 35203-3822
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Country | US
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Telephone | 205-415-1539
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Fax |
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Provider Business Mailing Address
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Address Line | 2214 3RD AVE N
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City | BIRMINGHAM
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State | AL
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Zip | 35203-3822
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARSHALL SHOEMAKER
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Credential |
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Telephone | 205-415-1539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VB0002X
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Taxonomy Name | Obesity Medicine (Obstetrics & Gynecology) Physician
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License Number | 21413
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License Number State | AL
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