Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 209822 | NC |
Y | 207Q00000X | Family Doctor | 38478 | AL |
N | 207QS0010X | Family Doctor - Sports Medicine | 2018-00555 | NC |
NPI | 1285020347 |
---|---|
Provider Name | Ian Douglas Mckeag |
First Address | Birmingham, AL 35255-5310 |
Second Address | Birmingham, AL 35205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2015 |
Last Update Date | 13/08/2019 |