Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 060347 | GA |
Y | 207U00000X | Nuclear Medicine Specialist | 31018 | AL |
NPI | 1558579375 |
---|---|
Provider Name | Samuel Almodovar-Reteguis |
First Address | Birmingham, AL 35255-5310 |
Second Address | Birmingham, AL 35233-2110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 09/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
051120018 | BCBS (01) | AL |
051120019 | BCBS (01) | AL |
051120021 | BCBS (01) | AL |
051120022 | BCBS (01) | AL |
051120023 | BCBS (01) | AL |
051120024 | BCBS (01) | AL |
051120025 | BCBS (01) | AL |
051120026 | BCBS (01) | AL |
051120028 | BCBS (01) | AL |
09770524 | (05) | MS |
131212 | (05) | AL |
131213 | (05) | AL |
131215 | (05) | AL |
131217 | (05) | AL |
131219 | (05) | AL |
131220 | (05) | AL |
131222 | (05) | AL |
131224 | (05) | AL |
131226 | (05) | AL |
131228 | (05) | AL |
51120027 | BCBS (01) | AL |
Z21039 | VIVA (01) | AL |