MEDICARE: ALABAMA PEDIATRIC PULMONARY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0214X	Pediatric Pulmonology Physician	4130	AL

General Provider Information

NPI Number	:	1215093224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALABAMA PEDIATRIC PULMONARY

Provider Business Mailing Address
First Line	:	2660 10TH AVENUE SOUTH
Second Line	:	STE 701
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-1628
Country	:	US
Telephone Number	:	205-776-8789
Fax Number	:	205-776-8792

Provider Business Practice Location Address
First Line	:	2660 10TH AVENUE SOUTH
Second Line	:	STE 701
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-1628
Country	:	US
Telephone Number	:	205-776-8789
Fax Number	:	205-776-8792

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	DANA MARIE BRASFIELD
Credential	:	MD
Telephone Number	:	205-776-8789

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	08/22/2020

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