=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306852041
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXANDER ORLOV D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 710 GASLIGHT BLVD STE. A
-----------------------------------------------------
City | LUFKIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75904-3153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-632-2468
-----------------------------------------------------
Fax | 936-632-0794
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 710 GASLIGHT BLVD STE. A
-----------------------------------------------------
City | LUFKIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75904-3153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-632-2468
-----------------------------------------------------
Fax | 936-632-0794
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | J4402
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------