Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 2935 | AL |
NPI | 1013935980 |
---|---|
Provider Name | Dr. Alvin Willis Stevens JR. |
First Address | Birmingham, AL 35226-3945 |
Second Address | Birmingham, AL 35226-3945 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |