Basic Information
| Provider Information | |||||||||
| NPI: | 1790280147 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DILLARD | ||||||||
| FirstName: | FREDDY | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PA-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 830550 MSC100 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352830550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006552656 | ||||||||
| FaxNumber: | 4128227411 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 PRINCETON AVE SW | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352111303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059771949 | ||||||||
| FaxNumber: | 4128227411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2018 | ||||||||
| LastUpdateDate: | 03/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA.1313 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.