Healthcare Provider Details

I. General information

NPI: 1710148465
Provider Name (Legal Business Name): DPMALLENPRAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HARGROVE RD E
TUSCALOOSA AL
35401-5027
US

IV. Provider business mailing address

215 HARGROVE RD E
TUSCALOOSA AL
35401-5027
US

V. Phone/Fax

Practice location:
  • Phone: 205-758-8809
  • Fax: 205-758-8870
Mailing address:
  • Phone: 205-758-8809
  • Fax: 205-758-8870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number294
License Number StateAL

VIII. Authorized Official

Name: MICHAEL R ALLEN
Title or Position: OWNER
Credential: DPM
Phone: 205-758-8809