Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 28767 | AL |
N | 207RP1001X | Pulmonary Disease | 33695 | CO |
NPI | 1053401737 |
---|---|
Provider Name | Dr. Karen A. Fagan |
First Address | Mobile, AL 36640-0480 |
Second Address | Mobile, AL 36617-2238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 12/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01336957 | (05) | CO |
06135261 | (05) | MS |
51547630 | BCBS - 575 STANTON RD (01) | AL |
51547639 | BCBS-2451 FILLINGIM ST (01) | AL |
51547640 | BCBS-3301 KNOLLWOOD DR (01) | AL |
G68094 | (02) |