Healthcare Provider Details

I. General information

NPI: 1891236949
Provider Name (Legal Business Name): IAN ALERRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 DILLON CIR
SPARTANBURG SC
29307-1030
US

IV. Provider business mailing address

280 DILLON CIR
SPARTANBURG SC
29307-1030
US

V. Phone/Fax

Practice location:
  • Phone: 864-585-3691
  • Fax: 864-591-3196
Mailing address:
  • Phone: 864-585-3691
  • Fax: 864-591-3196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: