Healthcare Provider Details

I. General information

NPI: 1558780619
Provider Name (Legal Business Name): ALAN PHARR RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 SHORE FRONT LN
WILSONVILLE AL
35186-8613
US

IV. Provider business mailing address

118 SHORE FRONT LN
WILSONVILLE AL
35186-8613
US

V. Phone/Fax

Practice location:
  • Phone: 205-777-8647
  • Fax: 205-701-8624
Mailing address:
  • Phone: 205-777-8647
  • Fax: 205-701-8624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P1004X
TaxonomyPulmonary Diagnostics Registered Respiratory Therapist
License Number1214
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: