Individual
WANDA K BERNREUTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
619 19TH STREET SOUTH, BIRMINGHAM, AL 35233
(205) 934-4011
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
10675
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000015973
BLUE CROSS
AL
01
—
00124781
MISSISSIPPI MEDICAID
MS
05
—
009910035
—
AL
05
—
009934819
—
AL
05
—
009934882
—
AL
01
—
010033CC76033
SECTION 1011
AL
01
—
051505888
BLUE CROSS
AL
01
—
051511503
BLUE CROSS
AL
01
—
051512726
BLUE CROSS
AL
01
—
C76033
VIVA
AL
Enumeration date
05/23/2006
Last updated
07/05/2011
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