Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | AL3223 | AL |
Y | 213EG0000X | General Practice | AL3223 | AL |
NPI | 1003918467 |
---|---|
Provider Name | James David Aswell |
First Address | Jasper, AL 35504 |
Second Address | Jasper, AL 35504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 17/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
90180 | BLUE CROSS BLUE SHIELD AL (01) | AL |