=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669563649
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERWIN HARRY PEYTON JR. MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 09/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 S 4TH ST SUITE B
-----------------------------------------------------
City | GADSDEN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35901-5218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-547-6969
-----------------------------------------------------
Fax | 256-547-4076
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1095 OLIVER DR
-----------------------------------------------------
City | GADSDEN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35904-9363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-547-6969
-----------------------------------------------------
Fax | 256-547-4076
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number | 08115
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------