=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225175920
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALAN M DEMBY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2007
-----------------------------------------------------
Last Update Date | 05/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 AMALIA DR
-----------------------------------------------------
City | BUCKHANNON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26201-2239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-460-7901
-----------------------------------------------------
Fax | 304-460-7909
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 AMALIA DR
-----------------------------------------------------
City | BUCKHANNON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26201-2239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-460-7901
-----------------------------------------------------
Fax | 304-460-7909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 21848
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------