Provider Demographics
NPI:1063517118
Name:POU, BELFONDIA (MD)
Entity type:Individual
Prefix:DR
First Name:BELFONDIA
Middle Name:
Last Name:POU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 NORMANDIE DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2711
Mailing Address - Country:US
Mailing Address - Phone:334-284-6755
Mailing Address - Fax:334-284-6756
Practice Address - Street 1:2031 NORMANDIE DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2711
Practice Address - Country:US
Practice Address - Phone:334-284-6755
Practice Address - Fax:334-284-6756
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000099651Medicaid
AL000099651Medicaid
ALG87894Medicare UPIN