Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 6989 | AL |
NPI | 1023127982 |
---|---|
Provider Name | Dr. Michael A Mcewen |
First Address | Gadsden, AL 35903-1141 |
Second Address | Gadsden, AL 35903-1141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03541 | BCBS-AL (01) | AL |
C75215 | (02) | AL |