1275768145 NPI number — JUSTIN ARNOLD DO, MPH

Table of content: JUSTIN ARNOLD DO, MPH (NPI 1275768145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275768145 NPI number — JUSTIN ARNOLD DO, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARNOLD
Provider First Name:
JUSTIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO, MPH
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1275768145
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1887 SHADES CREST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VESTAVIA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35216-1421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-381-2525
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UAB DEPARTMENT OF EMERGENCY MEDICINE
Provider Second Line Business Practice Location Address:
OHB 251, 6119 19TH STREET SOUTH
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35249-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-975-9358
Provider Business Practice Location Address Fax Number:
205-934-9155
Provider Enumeration Date:
05/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  69171 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: DO.1484 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104600200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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