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General NPI Number Information
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NPI Number | 1578671665
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Entity Type | Individual
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Provider Name | ALAN L MAST DPM
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Gender | Male
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 333 N JEBAVY DR
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City | LUDINGTON
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State | MI
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Zip | 49431-1923
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Country | US
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Telephone | 231-843-2690
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Fax | 231-843-4338
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Provider Business Mailing Address
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Address Line | 333 N JEBAVY DR
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City | LUDINGTON
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State | MI
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Zip | 49431-1923
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Country | US
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Telephone | 231-843-2690
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Fax | 231-843-4338
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 5901001496
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License Number State | MI
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