Individual
KENNETH B WAITES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
619 19TH STREET SOUTH, BIRMINGHAM, AL 35233
(205) 934-6600
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
101513
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010033CC76902
SECTION 1011
AL
01
—
C76902
VIVA
AL
Enumeration date
07/26/2006
Last updated
07/08/2007
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