=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235254384
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARRELL EUGENE RELIFORD ALLEY M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 11/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 904 S BECKHAM AVE ATTN AMBER ALLEN
-----------------------------------------------------
City | TYLER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75701-1906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-596-3588
-----------------------------------------------------
Fax | 903-594-2038
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 186 MCKINLEY SCOTT LN
-----------------------------------------------------
City | EASTOVER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29044-9087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-353-2217
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 23756
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------