Healthcare Provider Details

I. General information

NPI: 1083618839
Provider Name (Legal Business Name): CHARLES T ALLRED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 E PRESCOTT RD
SALINA KS
67401-7408
US

IV. Provider business mailing address

651 E PRESCOTT RD
SALINA KS
67401-7408
US

V. Phone/Fax

Practice location:
  • Phone: 785-825-7251
  • Fax: 785-825-6887
Mailing address:
  • Phone: 785-825-7251
  • Fax: 785-825-6887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0418555
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18555
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: