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General NPI Number Information
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NPI Number | 1376699546
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Entity Type | Organization
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Legal Business Name | SOUTHEAST UROLOGY NETWORK PC
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Dates
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Enumeration Date | 01/28/2007
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 7420 GUTHRIE DR N STE. 111
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City | SOUTHAVEN
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State | MS
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Zip | 38671-5876
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Country | US
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Telephone | 662-349-2220
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Fax | 662-349-4414
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Provider Business Mailing Address
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Address Line | PO BOX 756
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City | MEMPHIS
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State | TN
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Zip | 38101-0756
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Country | US
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Telephone | 901-527-7100
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Fax | 901-527-7124
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALAN MICHAEL ALABASTER
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Credential | M.D.
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Telephone | 901-527-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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