MEDICARE: ALAN M UNELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician		TX

General Provider Information

NPI Number	:	1366543621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN M UNELL M.D.

Provider Business Mailing Address
First Line	:	4375 BOOTH CALLOWAY RD
Second Line	:	SUITE 501
City	:	FT WORTH
State	:	TX
Zip	:	76180-8359
Country	:	US
Telephone Number	:	817-595-2522
Fax Number	:	817-284-8380

Provider Business Practice Location Address
First Line	:	4375 BOOTH CALLOWAY RD
Second Line	:	SUITE 501
City	:	FT WORTH
State	:	TX
Zip	:	76180-8359
Country	:	US
Telephone Number	:	817-595-2522
Fax Number	:	817-284-8380

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/08/2007

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