Individual
MARK M. TAVAKOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2010 BROOKWOOD MEDICAL CTR DR, BIRMINGHAM, AL 35209-6804
(205) 989-1080
(205) 989-1087
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
6173
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00003018
—
AL
01
—
051549062
BCBS
AL
01
—
051549063
BCBS
AL
01
—
051549064
BCBS
AL
01
—
051594516
BCBS
AL
05
—
09259043
—
MS
05
—
101703
—
AL
05
—
101704
—
AL
05
—
101705
—
AL
05
—
105513
—
AL
01
—
C71588
VIVA
AL
01
—
P00653636
RAILROAD MEDICARE
AL
Enumeration date
06/28/2005
Last updated
11/04/2011
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