Provider Demographics
NPI:1396799805
Name:EYAL, FABIEN G (MD/PHD)
Entity type:Individual
Prefix:
First Name:FABIEN
Middle Name:G
Last Name:EYAL
Suffix:
Gender:M
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-415-1055
Mailing Address - Fax:251-415-1045
Practice Address - Street 1:1700 CENTER ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3301
Practice Address - Country:US
Practice Address - Phone:251-415-1055
Practice Address - Fax:251-415-1045
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL187662080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51023789OtherBLUE CROSS
FL255606500Medicaid
AL000023789Medicaid
MS00114886Medicaid
LA1522554Medicaid
AL47-10012OtherUNITED HEALTH CARE
LA1522554Medicaid