Individual
MS. LISA DIANNE DOVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
619 19TH ST S, P 915, BIRMINGHAM, AL 35233-1900
(205) 975-0512
(205) 975-6404
Mailing address
619 19TH ST S, P 915, BIRMINGHAM, AL 35233-1900
(205) 975-0512
(205) 975-6404
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
491
AL
363AS0400X
Surgical Physician Assistant
PA491
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009943016
—
AL
05
—
PAYEE #529916450
—
AL
Enumeration date
11/29/2006
Last updated
05/01/2013
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