1669438370 NPI number — DR. PETER JAMES DEFRANCO JR. D. C.

Table of content: (NPI 1790100220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669438370 NPI number — DR. PETER JAMES DEFRANCO JR. D. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEFRANCO
Provider First Name:
PETER
Provider Middle Name:
JAMES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
D. C.
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:
1669438370
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3166 ALLISON BON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUEYTOWN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35023-1641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-491-6881
Provider Business Mailing Address Fax Number:
205-491-3919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3166 ALLISON BON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUEYTOWN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35023-1641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-491-6881
Provider Business Practice Location Address Fax Number:
205-491-3919
Provider Enumeration Date:
04/21/2006

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: 111N00000X , with the licence number:  1105 , 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: 2815 . This is a "HEALTHSPRING" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 631206410 . This is a "TAX ID" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 4410053 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 44788 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".