1053358283 NPI number — STEPHANIE RAYZ CLEVELAND P.A.-C.

Table of content: MR. BIRENDRA NATH DAS M.D. (NPI 1992878672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053358283 NPI number — STEPHANIE RAYZ CLEVELAND P.A.-C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLEVELAND
Provider First Name:
STEPHANIE
Provider Middle Name:
RAYZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAYZ
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.A.-C.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1053358283
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6701 AIRPORT BLVD
Provider Second Line Business Mailing Address:
SUITE D-330
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36608-6705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-607-9797
Provider Business Mailing Address Fax Number:
251-607-9761

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6701 AIRPORT BLVD
Provider Second Line Business Practice Location Address:
SUITE D-330
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36608-6705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-607-9797
Provider Business Practice Location Address Fax Number:
251-607-9761
Provider Enumeration Date:
05/31/2006

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: 363A00000X , with the licence number:  PA-176 , 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: 000008509 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 510-08506 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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