Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 00010293 | AL |
NPI | 1164449518 |
---|---|
Provider Name | Kenneth Wayne Bramlett |
First Address | Vestavia Hills, AL 35216-2805 |
Second Address | Vestavia Hills, AL 35216-2805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 22/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
051522758 | (05) | AL |
C75322 | (02) | AL |