=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518975697
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALAN I GURWOOD D.P.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2006
-----------------------------------------------------
Last Update Date | 03/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 MAGNOLIA AVE SUITE H
-----------------------------------------------------
City | BRIDGETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08302-1760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-451-2900
-----------------------------------------------------
Fax | 856-451-2866
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 MAGNOLIA AVE SUITE H
-----------------------------------------------------
City | BRIDGETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08302-1760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-451-2900
-----------------------------------------------------
Fax | 856-451-2866
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 25MD00102600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------