Provider Demographics
NPI:1831144666
Name:PEPPER, JEREMY SHAWN (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:SHAWN
Last Name:PEPPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2350 SCHILLINGER ROAD SOUTH
Mailing Address - Street 2:STE A
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695
Mailing Address - Country:US
Mailing Address - Phone:251-445-7614
Mailing Address - Fax:251-410-6127
Practice Address - Street 1:2350 SCHILLINGER ROAD SOUTH
Practice Address - Street 2:STE A
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695
Practice Address - Country:US
Practice Address - Phone:251-445-7614
Practice Address - Fax:251-410-6127
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2014-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL26756207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAI24590Medicare UPIN