Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 10586 | AL |
N | 207QA0401X | Family Doctor - Addiction Medicine | 10586 | AL |
NPI | 1831287127 |
---|---|
Provider Name | Henry Michael Born |
First Address | Hokes Bluff, AL 35903-7507 |
Second Address | Hokes Bluff, AL 35903-7507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 27/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009953560 | (05) | AL |
51503789 | BCBS OF AL (01) | AL |
C72008 | (02) | AL |