Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | DO799 | AL |
NPI | 1003863101 |
---|---|
Provider Name | Dr. Paul Bryant Glisson |
First Address | Birmingham, AL 35283-0469 |
Second Address | Fairhope, AL 36532-1812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009917185559400060 | (05) | AL |
H48074 | (02) | AL |