Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 00010407 | AL |
NPI | 1255372561 |
---|---|
Provider Name | Dr. David C. Mayer |
First Address | Mobile, AL 36608-6705 |
Second Address | Mobile, AL 36608-6705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0019289 | (05) | MS |
510-77273 | BLUE CROSS BLUE SHIELD (01) | AL |
C76766 | (02) | AL |