Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0127X | Trauma Surgeon | 14648 | AL |
N | 2086S0127X | Trauma Surgeon | MD08201R | LA |
NPI | 1487675740 |
---|---|
Provider Name | Sidney B Brevard |
First Address | Mobile, AL 36640-0480 |
Second Address | Mobile, AL 36617-2238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2006 |
Last Update Date | 12/05/2015 |