Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 16873 | AL |
NPI | 1063406627 |
---|---|
Provider Name | James Kent Pitcock |
First Address | Mobile, AL 36606-2457 |
Second Address | Mobile, AL 36608-1756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 19/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4244442 | AETNA PROVIDER # (01) | AL |
51034527 | BLUE CROSS PROVIDER # (01) | AL |
E20556 | (02) | |
E20556 | HEALTHSPRING PROVIDER # (01) | AL |