Basic Information
| Provider Information | |||||||||
| NPI: | 1477597151 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARGASON | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | EPSTEIN | ||||||||
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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 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 619 19TH STREET SOUTH | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059344011 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 12/20/2016 | ||||||||
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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 | 2084P0800X | 15743 | AL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 000084054 | 05 | AL | MEDICAID | 051502077 | 01 | AL | BC FEDERAL EHBP | OTHER | 51598463 | 01 | AL | BLUE CROSS | OTHER | 051110418 | 01 | AL | BLUE CROSS | OTHER | 51598465 | 01 | AL | BLUE CROSS | OTHER | E99475 | 01 | AL | VIVA | OTHER | 000084054 | 01 | AL | BLUE CROSS | OTHER | 051047504 | 01 | AL | BLUE CROSS | OTHER | 051598027 | 01 | AL | BLUE CROSS | OTHER | 110066 | 05 | AL | MEDICAID | 123241 | 05 | AL | MEDICAID | 51598468 | 01 | AL | BLUE CROSS | OTHER | 330500280 | 01 | AL | MEDICAID REHAB | OTHER |