Basic Information
| Provider Information | |||||||||
| NPI: | 1023063559 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEARDEN | ||||||||
| FirstName: | DONNA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 55310 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352555310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057319701 | ||||||||
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| Practice Location | |||||||||
| Address1: | 619 19TH STREET SOUTH | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059344011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 07/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 14106 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 14106 | AL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 000025165 | 05 | AL | MEDICAID | 009912052 | 01 | AL | ALABAMA MEDICAID | OTHER | 051538337 | 01 | AL | BC BS MEDICAID | OTHER | 051543919 | 01 | AL | BLUE CROSS BLUE SHIELD OF | OTHER | 051543921 | 01 | AL | BLUE CROSS BLUE SHIELD OF | OTHER | 110035846 | 01 | AL | RAILROAD MEDICARE | OTHER | 009912051 | 01 | AL | ALABAMA MEDICAID | OTHER | 051543916 | 01 | AL | BLUE CROSS BLUE SHIELD OF | OTHER | 110100915 | 01 | AL | RAILROAD MEDICARE | OTHER | 009912053 | 01 | AL | ALABAMA MEDICAID | OTHER | 051025165 | 01 | AL | BLUE CROSS | OTHER | 051543918 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER |