Provider Demographics
NPI:1871075937
Name:BORTMAS-SHAMMAA, ERICA BREANNE (MD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:BREANNE
Last Name:BORTMAS-SHAMMAA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 GREENO RD S STE B
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1905
Mailing Address - Country:US
Mailing Address - Phone:251-929-3424
Mailing Address - Fax:
Practice Address - Street 1:300 GREENO RD S STE B
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1905
Practice Address - Country:US
Practice Address - Phone:251-929-3424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL.4814R390200000X
ALMD.42997207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program