Healthcare Provider Details

I. General information

NPI: 1740237148
Provider Name (Legal Business Name): ALVORD MEDICAL CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E BYPASS 287 STE A
ALVORD TX
76225-7778
US

IV. Provider business mailing address

PO BOX 49
ALVORD TX
76225-0049
US

V. Phone/Fax

Practice location:
  • Phone: 940-427-2858
  • Fax: 940-427-2857
Mailing address:
  • Phone: 940-427-2858
  • Fax: 940-427-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFERSON B ALLING
Title or Position: MD/OWNER
Credential: MD
Phone: 940-627-7829