Provider Demographics
NPI:1194877753
Name:DAWKINS, DERROL (MD)
Entity type:Individual
Prefix:
First Name:DERROL
Middle Name:
Last Name:DAWKINS
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 1:5232 CLAIRMONT AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-4040
Mailing Address - Country:US
Mailing Address - Phone:205-595-4966
Mailing Address - Fax:
Practice Address - Street 1:401 VALLEY AVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-3805
Practice Address - Country:US
Practice Address - Phone:205-941-1414
Practice Address - Fax:205-941-1313
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0010039174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL008403610Medicaid
ALC-76631OtherVIVA HEALTH
AL51013242OtherBCBS OF AL
AL2635171001OtherCIGNA
ALC-76631Medicare UPIN