Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 25035 | AL |
N | 207RH0003X | Hematology & Oncology | 49477 | TN |
NPI | 1053348037 |
---|---|
Provider Name | Dr. Clint Daniel Kingsley |
First Address | Huntsville, AL 35804-8428 |
Second Address | Florence, AL 35630-3263 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 01/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102961 | (05) | AL |
104703 | (05) | AL |
1528883 | (05) | TN |
51012794 | BLUE CROSS OF ALABAMA (01) | AL |
510-50070 | BCBS OF ALABAMA (01) | AL |
510I110169 | MEDICARE NUMBER (01) | AL |
51547906 | BLUE CROSS OF ALABAMA (01) | AL |
528701110 | (05) | AL |
CA0084 | RR MEDICARE (01) | AL |
I28787 | (02) | AL |
P00657989 | RR MEDICARE NUMBER (01) | AL |