Provider Demographics
NPI:1043360605
Name:POOLE UROLOGY PC
Entity Type:Organization
Organization Name:POOLE UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:EMORY
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-877-2935
Mailing Address - Street 1:2018 BROOKWOOD MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6870
Mailing Address - Country:US
Mailing Address - Phone:205-877-2935
Mailing Address - Fax:205-870-1759
Practice Address - Street 1:2018 BROOKWOOD MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 302
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6870
Practice Address - Country:US
Practice Address - Phone:205-877-2935
Practice Address - Fax:205-870-1759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18517208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00009914615Medicaid
AL00009914615Medicaid