Healthcare Provider Details

I. General information

NPI: 1235111840
Provider Name (Legal Business Name): ALAN L DANSBERRY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 POCKET RD
HURT VA
24563-2023
US

IV. Provider business mailing address

527 POCKET RD
HURT VA
24563-2023
US

V. Phone/Fax

Practice location:
  • Phone: 434-324-9150
  • Fax: 434-324-8248
Mailing address:
  • Phone: 434-324-9150
  • Fax: 434-324-8248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110001328
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: