Healthcare Provider Details

I. General information

NPI: 1225019706
Provider Name (Legal Business Name): JOHN FRANK DISHUCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 JACK WARNER PKWY NE SUITE C
TUSCALOOSA AL
35404-5751
US

IV. Provider business mailing address

535 JACK WARNER PKWY NE SUITE C
TUSCALOOSA AL
35404-5751
US

V. Phone/Fax

Practice location:
  • Phone: 205-553-2252
  • Fax: 205-553-3326
Mailing address:
  • Phone: 205-553-2252
  • Fax: 205-553-3326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number12867
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: