Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | MD.25007 | AL |
N | 208000000X | Pediatrician | MD.25007 | AL |
Y | 2080P0204X | Pediatric Emergency Doctor | MD.25007 | AL |
NPI | 1245228006 |
---|---|
Provider Name | Jennifer Eidson Mccain |
First Address | Birmingham, AL 35233-1711 |
Second Address | Birmingham, AL 35233-1711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 08/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I06018 | (02) | AL |