Healthcare Provider Details

I. General information

NPI: 1235254384
Provider Name (Legal Business Name): DARRELL EUGENE RELIFORD ALLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 S BECKHAM AVE ATTN AMBER ALLEN
TYLER TX
75701-1906
US

IV. Provider business mailing address

186 MCKINLEY SCOTT LN
EASTOVER SC
29044-9087
US

V. Phone/Fax

Practice location:
  • Phone: 903-596-3588
  • Fax: 903-594-2038
Mailing address:
  • Phone: 803-353-2217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number23756
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: