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General NPI Number Information
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NPI Number | 1639469547
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Entity Type | Organization
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Legal Business Name | ENT IMAGING, LLC
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 2700 10TH AVE S SUITE 502
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City | BIRMINGHAM
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State | AL
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Zip | 35205-1200
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Country | US
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Telephone | 205-933-2952
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Fax | 205-933-5893
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Provider Business Mailing Address
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Address Line | 2700 10TH AVE S SUITE 502
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City | BIRMINGHAM
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State | AL
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Zip | 35205-1200
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Country | US
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Telephone | 205-933-2952
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Fax | 205-933-5893
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LEV H BRAGG
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Credential | M.D.
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Telephone | 205-933-2952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0901X
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Taxonomy Name | Otology & Neurotology Physician
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License Number | 16561
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 10997
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License Number State | AL
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