1932125101 NPI number — CAESAR JOHN CORTOPASSI M.D.

Table of content: CAESAR JOHN CORTOPASSI M.D. (NPI 1932125101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932125101 NPI number — CAESAR JOHN CORTOPASSI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORTOPASSI
Provider First Name:
CAESAR
Provider Middle Name:
JOHN
Provider Name Prefix Text:
Provider Name Suffix Text:
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:
1932125101
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5295 PRESERVE PARKWAY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
HOOVER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-987-4444
Provider Business Mailing Address Fax Number:
205-987-4451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5295 PRESERVE PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HOOVER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-987-4444
Provider Business Practice Location Address Fax Number:
205-987-4451
Provider Enumeration Date:
07/14/2006

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: 208000000X , with the licence number:  8529 , 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: 51510842 . This is a "BLUE CROSS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000026582 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009910995 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51026582 . This is a "BLUE CROSS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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