Provider Demographics
NPI:1033276035
Name:MCGIVERN, BRENDA LAYTON (DO)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LAYTON
Last Name:MCGIVERN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:ANN
Other - Last Name:LAYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-0670
Mailing Address - Country:US
Mailing Address - Phone:334-289-5770
Mailing Address - Fax:334-289-5758
Practice Address - Street 1:300 W PETTUS ST
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-2830
Practice Address - Country:US
Practice Address - Phone:334-289-5770
Practice Address - Fax:334-289-5758
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO10622080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL107779Medicaid
AL51596280OtherBLUE CROSS