Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 2402 | AL |
NPI | 1255754032 |
---|---|
Provider Name | Jack Trigg JR. |
First Address | Birmingham, AL 35205-1606 |
Second Address | Birmingham, AL 35205-1606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2014 |
Last Update Date | 29/01/2014 |