Provider Demographics
NPI: | 1508883489 |
---|---|
Name: | CAVENDER, ALLISON M (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | ALLISON |
Middle Name: | M |
Last Name: | CAVENDER |
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: | 703 VOLKER HALL |
Mailing Address - Street 2: | |
Mailing Address - City: | BIRMINGHAM |
Mailing Address - State: | AL |
Mailing Address - Zip Code: | 35294-0001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 205-934-3795 |
Mailing Address - Fax: | 205-975-2499 |
Practice Address - Street 1: | 1616 6TH AVE S |
Practice Address - Street 2: | |
Practice Address - City: | BIRMINGHAM |
Practice Address - State: | AL |
Practice Address - Zip Code: | 35233-1788 |
Practice Address - Country: | US |
Practice Address - Phone: | 205-939-9585 |
Practice Address - Fax: | 205-975-6503 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-16 |
Last Update Date: | 2007-08-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AL | 23111 | 208000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AL | 009999775 | Medicaid | |
AL | 009968690 | Medicaid | |
AL | 515-05239 | Other | BC BS |
AL | 009970310 | Medicaid | |
H77815 | Other | VIVA | |
AL | 515-05239 | Other | BC BS |
AL | 009968690 | Medicaid | |
AL | 51504918 | Medicare ID - Type Unspecified |