MEDICARE: DESTIN ORTHOPEDICS,PL

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	207X00000X	Orthopaedic Surgery Physician	MD9362	AL

General Provider Information

NPI Number	:	1548565773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESTIN ORTHOPEDICS,PL

Provider Business Mailing Address
First Line	:	36008 EMERALD COAST PKWY
Second Line	:	SUITE 102A
City	:	DESTIN
State	:	FL
Zip	:	32541-4792
Country	:	US
Telephone Number	:	251-665-5127
Fax Number	:	251-665-5159

Provider Business Practice Location Address
First Line	:	5613 COTTAGE HILL RD
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36609-4210
Country	:	US
Telephone Number	:	251-665-5127
Fax Number	:	251-665-5159

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HERBERT VICTOR ALLEN III
Credential	:	M.D.
Telephone Number	:	251-665-5127

Provider Enumeration Date	:	01/19/2011
Last Update Date	:	06/18/2012

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