Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 15405 | AL |
NPI | 1083643142 |
---|---|
Provider Name | Dr. George T Koulianos |
First Address | Mobile, AL 36607-3520 |
Second Address | Mobile, AL 36607-3520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
051088782 | (05) | AL |
88782 | BLUE CROSS (01) | AL |
E47451 | (02) | AL |