Individual
JIMMIE COUNCIL BLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
100 MEMORIAL HOSPITAL DR, SUITE 3A, MOBILE, AL 36608-1183
(251) 342-2641
(251) 343-9507
Mailing address
100 MEMORIAL HOSPITAL DR, SUITE 3A, MOBILE, AL 36608-1183
(251) 342-2641
(251) 343-9507
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1692
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05110015
BLUE CROSS/BLUE SHIELD
AL
05
—
1093048332
—
AL
Enumeration date
09/17/2009
Last updated
07/27/2010
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