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General NPI Number Information
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NPI Number | 1194071258
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Entity Type | Organization
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Legal Business Name | VALLEY VEIN AND COSMETICS LLC
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Dates
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Enumeration Date | 07/26/2012
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Last Update Date | 07/26/2012
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Provider Practice Location Address
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Address Line | 1 HOSPITAL DR SW
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City | HUNTSVILLE
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State | AL
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Zip | 35801-6455
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Country | US
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Telephone | 256-881-0020
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Fax |
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Provider Business Mailing Address
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Address Line | 1 MUIRFIELD LN SE
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City | HUNTSVILLE
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State | AL
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Zip | 35802-1289
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Country | US
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Telephone | 256-881-0020
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TRACY ALAN LOWERY
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Credential | M.D.
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Telephone | 256-881-0020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 16783
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License Number State | AL
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