Healthcare Provider Details

I. General information

NPI: 1437653037
Provider Name (Legal Business Name): EXPRESS MRO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 US HIGHWAY 31 N
DEATSVILLE AL
36022-2714
US

IV. Provider business mailing address

2175 US HIGHWAY 31 N
DEATSVILLE AL
36022-2714
US

V. Phone/Fax

Practice location:
  • Phone: 334-358-3777
  • Fax: 334-358-0026
Mailing address:
  • Phone: 334-568-2120
  • Fax: 334-568-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEVEN L ALLEN
Title or Position: MD/OWNER
Credential: MD
Phone: 334-358-3777