Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD8821 | AL |
NPI | 1326147828 |
---|---|
Provider Name | Jean Senecal |
First Address | Eufaula, AL 36027-1851 |
Second Address | Eufaula, AL 36027-1851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 23/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1326147828 | (05) | AL |
184129545A | (05) | GA |
515-47871 | BCBS ALABAMA (01) | AL |
C70390 | (02) | AL |