Provider Demographics
NPI:1043618226
Name:FAMILY MEDICINE SPECIALIST LLC
Entity Type:Organization
Organization Name:FAMILY MEDICINE SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCBREARTY
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:251-410-6334
Mailing Address - Street 1:8367 MORPHY AVE
Mailing Address - Street 2:STE B
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3653
Mailing Address - Country:US
Mailing Address - Phone:251-410-6334
Mailing Address - Fax:
Practice Address - Street 1:8367 MORPHY AVE
Practice Address - Street 2:STE B
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3653
Practice Address - Country:US
Practice Address - Phone:251-410-6334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6713173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC72568Medicare UPIN
AL000004068Medicare PIN