Provider Demographics
NPI:1366471492
Name:BRICE ROSHELL, JADE K (MD)
Entity Type:Individual
Prefix:DR
First Name:JADE
Middle Name:K
Last Name:BRICE ROSHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JADE
Other - Middle Name:K
Other - Last Name:BRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 830605
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283-0605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 1ST ST N
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8703
Practice Address - Country:US
Practice Address - Phone:205-620-7004
Practice Address - Fax:205-620-8688
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL34258207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4J337Medicare ID - Type Unspecified
LA1046124Medicaid
GA238960519AMedicaid
124930Medicare UPIN