Provider Demographics
NPI:1740205814
Name:FUGAZZOTTO, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:FUGAZZOTTO
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 1:1112 GENE REED RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-2405
Mailing Address - Country:US
Mailing Address - Phone:205-836-8691
Mailing Address - Fax:205-836-8170
Practice Address - Street 1:1112 GENE REED RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-2405
Practice Address - Country:US
Practice Address - Phone:205-836-8691
Practice Address - Fax:205-836-8170
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5925208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51506457OtherBC/BS
AL612099OtherUNITED HEALTH CARE
AL000025902Medicaid
AL1211056OtherCIGNA
AL51025902OtherBC/BS
ALC76667Medicare UPIN