Provider Demographics
NPI:1396774105
Name:FOUTY, CHRISTINE L (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:FOUTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 DAUPHIN ST
Mailing Address - Street 2:BUILDING B SUITE 118
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-4060
Mailing Address - Country:US
Mailing Address - Phone:251-545-4579
Mailing Address - Fax:251-287-1466
Practice Address - Street 1:5 MOBILE INFIRMARY CIR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3513
Practice Address - Country:US
Practice Address - Phone:251-545-4579
Practice Address - Fax:251-287-1466
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.26568207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-04617OtherBCBS
AL009935963Medicaid
AL515-32931OtherBCBS
AL009936029Medicaid
AL009935351Medicaid
AL009935966Medicaid
AL009938101Medicaid
AL009935964Medicaid
AL1396774105OtherTRICARE SOUTH
AL1396774105OtherTRICARE SOUTH
AL009935964Medicaid
AL009938101Medicaid
AL051532931Medicare PIN
ALG47944Medicare UPIN