Individual
LOGAN BEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
625 19TH ST S, BIRMINGHAM, AL 35233-1900
(205) 934-3640
Mailing address
625 19TH ST S, BIRMINGHAM, AL 35233-1900
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD.49509
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/27/2023
Last updated
10/28/2025
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