MEDICARE: ALLERGY & FAMILY MEDICINE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	7306	AL

General Provider Information

NPI Number	:	1457711863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLERGY & FAMILY MEDICINE, PC

Provider Business Mailing Address
First Line	:	1642 PELHAM RD S
Second Line	:	SUITE A
City	:	JACKSONVILLE
State	:	AL
Zip	:	36265-3312
Country	:	US
Telephone Number	:	256-365-2233
Fax Number	:	256-365-2187

Provider Business Practice Location Address
First Line	:	1642 PELHAM RD S
Second Line	:	SUITE A
City	:	JACKSONVILLE
State	:	AL
Zip	:	36265-3312
Country	:	US
Telephone Number	:	256-365-2233
Fax Number	:	256-365-2187

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KEWAL K VERMA
Credential	:	M.D.
Telephone Number	:	256-365-2233

Provider Enumeration Date	:	02/26/2016
Last Update Date	:	02/26/2016

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