1699753111 NPI number — DR. GREGORY A ZIEMAN DMD

Table of content: DR. GREGORY A ZIEMAN DMD (NPI 1699753111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699753111 NPI number — DR. GREGORY A ZIEMAN DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIEMAN
Provider First Name:
GREGORY
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
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:
1699753111
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5901 GRELOT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36609-3603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-344-6191
Provider Business Mailing Address Fax Number:
251-344-6794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5901 GRELOT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36609-3603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-344-6191
Provider Business Practice Location Address Fax Number:
251-344-6794
Provider Enumeration Date:
01/04/2006

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: 1223S0112X , with the licence number:  3814 , 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: 90524 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 439306 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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