Healthcare Provider Details

I. General information

NPI: 1871692939
Provider Name (Legal Business Name): EARL W MCALLISTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 RIVIERA DR
TAMPA FL
33606-3807
US

IV. Provider business mailing address

561 RIVIERA DR
TAMPA FL
33606-3807
US

V. Phone/Fax

Practice location:
  • Phone: 813-335-5325
  • Fax:
Mailing address:
  • Phone: 813-335-5325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME0047761
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberME0047761
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: