Provider Demographics
NPI:1437360435
Name:ALABAMA NEUROLOGICAL INSTITUTE
Entity Type:Organization
Organization Name:ALABAMA NEUROLOGICAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CAMILO
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-874-8787
Mailing Address - Street 1:513 BROOKWOOD BLVD
Mailing Address - Street 2:SUITE #405
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6862
Mailing Address - Country:US
Mailing Address - Phone:205-874-8787
Mailing Address - Fax:205-802-6801
Practice Address - Street 1:513 BROOKWOOD BLVD
Practice Address - Street 2:SUITE #405
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6862
Practice Address - Country:US
Practice Address - Phone:205-874-8787
Practice Address - Fax:205-802-6801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALJ321OtherMEDICARE GROUP
ALJ321OtherMEDICARE GROUP