Healthcare Provider Details

I. General information

NPI: 1376936898
Provider Name (Legal Business Name): ROBERT GRANT ALLENBACH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 AIRPORT BLVD
MOBILE AL
36608-3709
US

IV. Provider business mailing address

10558 EASTERN SHORE BLVD APT 527
SPANISH FORT AL
36527-5855
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-1000
  • Fax:
Mailing address:
  • Phone: 251-455-9828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number105085
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: