Unknown Individual – Otolaryngology Physician, NPI 1679565204
Excluded from federal healthcare programs (Medicare/Medicaid)
This provider is listed on the OIG List of Excluded Individuals/Entities (LEIE). Exclusion effective: 2017-03-20. Reason: License revocation, suspension, or surrender.
Otolaryngology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
PO BOX 1857
ALABASTER, AL 350072070
Phone: (205) 663-5840
Fax: (205) 664-2159
Type: Mailing
1st Street North, Scottrock, Alabaster, Shelby County, Alabama, 35007, United States
ALABASTER, AL 35007
Phone: (205) 663-5840
Fax: (205) 664-2159
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 35007)
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