Healthcare Provider Details

I. General information

NPI: 1518975697
Provider Name (Legal Business Name): ALAN I GURWOOD D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MAGNOLIA AVE SUITE H
BRIDGETON NJ
08302-1760
US

IV. Provider business mailing address

10 MAGNOLIA AVE SUITE H
BRIDGETON NJ
08302-1760
US

V. Phone/Fax

Practice location:
  • Phone: 856-451-2900
  • Fax: 856-451-2866
Mailing address:
  • Phone: 856-451-2900
  • Fax: 856-451-2866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00102600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: