Individual
MICHAEL BRYAN FAIRCLOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1714 9TH AVE S, BIRMINGHAM, AL 35205-3606
(205) 934-3581
Mailing address
P O BOX 55309, BIRMINGHAM, AL 35233
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
AL15983
AL
207R00000X
Internal Medicine Physician
Primary
15983
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009941841
—
AL
05
—
009941842
—
AL
01
—
051523273FAI
BLUE CROSS BLUE SHIELD
AL
01
—
051540412
BCBS
AL
01
—
051540413
BCBS
AL
Enumeration date
05/10/2006
Last updated
11/30/2015
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