1033114228 NPI number — BRYAN E BILLIONS MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033114228 NPI number — BRYAN E BILLIONS MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BILLIONS

Provider First Name:

BRYAN

Provider Middle Name:

E

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1033114228

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/30/2015

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2000A SOUTHBRIDGE PKWY

Provider Second Line Business Mailing Address:

STE 300

Provider Business Mailing Address City Name:

BIRMINGHAM

Provider Business Mailing Address State Name:

AL

Provider Business Mailing Address Postal Code:

35209-7718

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

205-871-4274

Provider Business Mailing Address Fax Number:

205-871-4301

Provider First Line Business Practice Location Address:

701 PRINCETON AVE SW

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BIRMINGHAM

Provider Business Practice Location Address State Name:

AL

Provider Business Practice Location Address Postal Code:

35211-1303

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

205-783-3000

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

06/15/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  20554 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 510-55471 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 511-60175 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 515-39376 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 105536 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 300116149 . This is a "RRMC" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 009941713 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 122574 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 511-09719 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 515-94508 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 7068546 . This is a "AETNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 000055471 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".