Healthcare Provider Details

I. General information

NPI: 1346082146
Provider Name (Legal Business Name): ALPHONZA BUTLER OWNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2469 DAUPHIN ISLAND PKWY
MOBILE AL
36605-3404
US

IV. Provider business mailing address

2469 DAUPHIN ISLAND PKWY
MOBILE AL
36605-3404
US

V. Phone/Fax

Practice location:
  • Phone: 251-295-0023
  • Fax:
Mailing address:
  • Phone: 251-295-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number991020389
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: