Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0300X | Geriatric Medicine | 110710 | MO |
Y | 207RG0300X | Geriatric Medicine | 27562 | AL |
NPI | 1013934561 |
---|---|
Provider Name | Dr. Kellie L Flood |
First Address | Birmingham, AL 35255-5309 |
Second Address | Birmingham, AL 35233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
126449 | MO-BLUE SHIELD (01) | |
H25206 | (02) |