Provider Demographics
NPI:1497786958
Name:LOSE, EDWARD J (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:LOSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1711
Mailing Address - Country:US
Mailing Address - Phone:205-638-9587
Mailing Address - Fax:
Practice Address - Street 1:1600 7TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-638-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.17705207P00000X, 208000000X, 2080P0204X
AL17705207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009935375Medicaid
AL051020867OtherBLUE CROSS
AL051535390OtherBLUE CROSS
AL9938841Medicaid
AL009938834Medicaid
AL009953715Medicaid
AL051535484OtherBLUE CROSS
AL051535501OtherBLUE CROSS
AL051535504OtherBLUE CROSS
AL125385Medicaid
AL148176Medicaid
AL051535486OtherBLUE CROSS
AL051535668OtherBLUE CROSS
MS09922541Medicaid
AL009938844Medicaid
AL051520541OtherBLUE CROSS
AL051547020OtherBLUE CROSS
AL105120Medicaid
AL511-30868OtherBCBS
AL9938838Medicaid
AL051113380OtherBLUE CROSS
AL051590996OtherBLUE CROSS
AL105106Medicaid
AL051535507OtherBLUE CROSS
AL051535671OtherBLUE CROSS
AL051594923OtherBLUE CROSS
AL009938832Medicaid
AL009938833Medicaid
AL051106841OtherBLUE CROSS
AL009938839Medicaid
AL009938842Medicaid
AL009938843Medicaid
AL051535487OtherBLUE CROSS
AL051543551OtherBLUE CROSS
AL142698Medicaid
AL511-36079OtherBCBS
AL148176Medicaid