Provider Demographics
NPI:1710986674
Name:FEAGIN, R WYATT II (MD)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:WYATT
Last Name:FEAGIN
Suffix:II
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 1:1009 MONTGOMERY HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-2805
Mailing Address - Country:US
Mailing Address - Phone:205-397-9400
Mailing Address - Fax:205-397-9455
Practice Address - Street 1:1009 MONTGOMERY HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-2805
Practice Address - Country:US
Practice Address - Phone:205-397-9400
Practice Address - Fax:205-397-9455
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00014092207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000087072Medicaid
ALD816Medicare PIN
AL000087072Medicaid
AL000087072Medicare ID - Type Unspecified