Provider Demographics
NPI:1437472404
Name:HAROLD E. BREITLING, JR., M.D.P.C.
Entity Type:Organization
Organization Name:HAROLD E. BREITLING, JR., M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BREITLING
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:205-932-3978
Mailing Address - Street 1:1716 TEMPLE AVE N
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:35555-1309
Mailing Address - Country:US
Mailing Address - Phone:205-932-3978
Mailing Address - Fax:205-932-3990
Practice Address - Street 1:1716 TEMPLE AVE N
Practice Address - Street 2:SUITE 5
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555-1309
Practice Address - Country:US
Practice Address - Phone:205-932-3978
Practice Address - Fax:205-932-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14148261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000014148Medicaid
ALC69972Medicare UPIN
AL000014148Medicaid