MEDICARE: PHILLIP L ALLRED AUD

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	231H00000X	Audiologist	50104	TX
2	237600000X	Audiologist-Hearing Aid Fitter	90002	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841271327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP L ALLRED AUD

Provider Business Mailing Address
First Line	:	PO BOX 6073
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77342-6073
Country	:	US
Telephone Number	:	936-291-2414
Fax Number	:	936-438-8088

Provider Business Practice Location Address
First Line	:	1911 22ND ST
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77340-4954
Country	:	US
Telephone Number	:	936-291-2414
Fax Number	:	936-438-8088

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	07/28/2008

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Directions to “ PHILLIP L ALLRED AUD” Practice Location

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