Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 13435 | AL |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 13435 | AL |
NPI | 1003974551 |
---|---|
Provider Name | Gerald Anthony Sweeney |
First Address | Wetumpka, AL 36092-1625 |
Second Address | Wetumpka, AL 36092-1625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 22/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009934870 | (05) | AL |
051097804 | BCBS (01) | AL |
C47296 | (02) | AL |