Healthcare Provider Details

I. General information

NPI: 1316940117
Provider Name (Legal Business Name): ALY E ALY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 NW EXPRESSWAY BLDG D SUITE 730
OKLAHOMA CITY OK
73112-4462
US

IV. Provider business mailing address

3366 NW EXPRESSWAY BLDG D SUITE 730
OKLAHOMA CITY OK
73112-4462
US

V. Phone/Fax

Practice location:
  • Phone: 405-951-4944
  • Fax: 405-951-4955
Mailing address:
  • Phone: 405-951-4944
  • Fax: 405-951-4955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number19742
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: