Provider Demographics
NPI:1477597151
Name:FARGASON, RACHEL EPSTEIN (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:EPSTEIN
Last Name:FARGASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:619 19TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-934-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL157432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000084054OtherBLUE CROSS
AL330500280OtherMEDICAID REHAB
AL051047504OtherBLUE CROSS
AL51598468OtherBLUE CROSS
AL051110418OtherBLUE CROSS
ALE99475OtherVIVA
AL051598027OtherBLUE CROSS
AL123241Medicaid
AL000084054Medicaid
AL051502077OtherBC FEDERAL EHBP
AL51598463OtherBLUE CROSS
AL110066Medicaid
AL51598465OtherBLUE CROSS
AL000084054Medicare ID - Type Unspecified