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Individual

DR. JAN E MATHISEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1940 ELMER J BISSELL RD, SUITE C, BIRMINGHAM, AL 35243-2941
(205) 638-5860
(205) 638-5879
Mailing address
1940 ELMER J BISSELL RD, SUITE C, BIRMINGHAM, AL 35243-2941
(205) 638-5860
(205) 638-5879

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
11165
AL
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
11165
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
18033
BLUE CROSS
AL
05
8804680
AL
Enumeration date
01/22/2007
Last updated
03/21/2013
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