Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 6940 | AL |
NPI | 1124132964 |
---|---|
Provider Name | Jere P Segrest |
First Address | Birmingham, AL 35255-5310 |
Second Address | Birmingham, AL 35233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17023 | (05) | AL |
17023 | BCBS OF AL (01) | AL |
29131 | HEALTHSPRING OF AL (01) | AL |
C74052 | VIVA (01) | AL |