1396763769 NPI number — WENDY REBECCA WALDROP MILLER MD

Table of content: WENDY REBECCA WALDROP MILLER MD (NPI 1396763769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396763769 NPI number — WENDY REBECCA WALDROP MILLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
WENDY
Provider Middle Name:
REBECCA WALDROP
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1396763769
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3188 BRADFORD PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35242-4602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-215-2529
Provider Business Mailing Address Fax Number:
205-971-1703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 MISSIONARY RDG STE 100
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:
35242-5203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-995-2529
Provider Business Practice Location Address Fax Number:
205-995-2539
Provider Enumeration Date:
07/17/2006

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: 207R00000X , with the licence number:  23674 , 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: 051597198 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051515998 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00046016 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 108950 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051553676 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com