Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | 2004003510 | MO |
Y | 207RI0200X | Infectious Disease | 23904 | AL |
NPI | 1073539201 |
---|---|
Provider Name | Edgar Turner Overton |
First Address | Birmingham, AL 35255-5310 |
Second Address | Birmingham, AL 35249-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 19/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
051117094 | BCBS (01) | AL |
051117095 | BCBS (01) | AL |
051117096 | BCBS (01) | AL |
051117103 | BCBS (01) | AL |
051117541 | BCBS (01) | AL |
06633521 | (05) | MS |
128931 | (05) | AL |
129007 | (05) | AL |
129009 | (05) | AL |
129010 | (05) | AL |
129011 | (05) | AL |
209297100 | (05) | MO |
I21554 | (02) |