Individual
DR. WAYNE EVAN FLEISIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1600 7TH AVENUE SOUTH, ACC SUITE 500, BIRMINGHAM, AL 35233
(205) 939-9193
Mailing address
3709 CRESTBROOK ROAD, BIRMINGHAM, AL 35223
(205) 969-2963
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
715
AL
103TC0700X
Clinical Psychologist
Primary
715
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000046084
—
AL
05
—
00915130
—
AL
05
—
101797
—
AL
01
—
1073608626
TRICARE SOUTH
AL
01
—
510-46083
BLUE CROSS BLUE SHIELD
AL
01
—
510-46084
BCBS
AL
01
—
515-01261
FEDERAL BC
AL
Enumeration date
10/03/2006
Last updated
04/16/2010
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