Individual
KIMBERLY M FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3125 INDEPENDENCE DR, SUITE 300A, BIRMINGHAM, AL 35209-4159
(205) 879-8206
(205) 271-3075
Mailing address
3125 INDEPENDENCE DR, SUITE 300A, BIRMINGHAM, AL 35209-4159
(205) 879-8206
(205) 271-3075
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
14105
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
I621
MEDICARE ID NUMBER
AL
Enumeration date
09/27/2006
Last updated
02/09/2016
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