Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 4648 | AL |
NPI | 1184703431 |
---|---|
Provider Name | Michael Mccracken |
First Address | Bessemer, AL 35020-4849 |
Second Address | Birmingham, AL 35233-2005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 14/12/2016 |