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General NPI Number Information
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NPI Number | 1700029758
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Entity Type | Organization
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Legal Business Name | L.A. ANESTHESIA LLC
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Dates
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Enumeration Date | 04/07/2009
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Last Update Date | 04/07/2009
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Provider Practice Location Address
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Address Line | 1613 N MCKENZIE ST
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City | FOLEY
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State | AL
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Zip | 36535-2247
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Country | US
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Telephone | 251-965-5393
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Fax | 251-971-1029
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Provider Business Mailing Address
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Address Line | PO BOX 137
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City | FOLEY
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State | AL
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Zip | 36536-0137
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Country | US
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Telephone | 251-965-5393
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Fax | 251-971-1029
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Authorized Official
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Title or Position | OWNER
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Name | WAYNE P COCKRELL JR.
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Credential | MD
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Telephone | 251-965-5393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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