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General NPI Number Information
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NPI Number | 1366817512
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Entity Type | Organization
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Legal Business Name | ALISTAIR CO, PLLC
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Dates
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Enumeration Date | 12/13/2015
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Last Update Date | 12/13/2015
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Provider Practice Location Address
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Address Line | 6201 N SUNCOAST BLVD
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City | CRYSTAL RIVER
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State | FL
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Zip | 34428-6712
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Country | US
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Telephone | 810-406-7175
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Fax |
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Provider Business Mailing Address
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Address Line | 1679 W SPRING MEADOW LOOP
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City | LECANTO
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State | FL
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Zip | 34461-7687
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Country | US
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Telephone | 810-406-7175
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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. ALISTAIR CO
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Credential | M.D.
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Telephone | 810-406-7175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | ME110427
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License Number State | FL
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