1851357933 NPI number — RAYMOND E POORE JR. M.D.

Table of content: RAYMOND E POORE JR. M.D. (NPI 1851357933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851357933 NPI number — RAYMOND E POORE JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POORE
Provider First Name:
RAYMOND
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
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:
1851357933
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 AFFLINK PL
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35406-2289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-366-9740
Provider Business Mailing Address Fax Number:
205-344-9992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1780 MCFARLAND BLVD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35406-2136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-345-7351
Provider Business Practice Location Address Fax Number:
205-345-8476
Provider Enumeration Date:
04/26/2006

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: 208800000X , with the licence number:  20891 , 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: 510-68253 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 114258 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114261 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 511-00713 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 114264 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 510-68237 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 510-68270 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 114255 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20891 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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