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General NPI Number Information
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NPI Number | 1659506004
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY ASSOCIATES WEST PC
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Dates
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Enumeration Date | 05/28/2009
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Last Update Date | 05/28/2009
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Provider Practice Location Address
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Address Line | 833 PRINCETON AVE SW SUITE 200D
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City | BIRMINGHAM
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State | AL
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Zip | 35211-1323
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Country | US
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Telephone | 205-786-5527
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Fax | 205-786-5529
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Provider Business Mailing Address
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Address Line | 833 PRINCETON AVE SW SUITE 200D
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City | BIRMINGHAM
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State | AL
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Zip | 35211-1323
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Country | US
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Telephone | 205-786-5527
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Fax | 205-786-5529
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK L. MAULDIN
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Credential | MD
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Telephone | 205-786-5527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 6455
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License Number State | AL
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