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NPI Code Detail

MEDICARE: DR. ALONZO J MAHURIN PHD., D.O.

MEDICARE: DR. ALONZO J MAHURIN PHD., D.O.
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
1207Q00000XFamily Medicine PhysicianDO210AL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4080141135OTHERALRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1630813275OTHERALCOMMERCIAL PRV
201 11606OTHERALUNITED HEALTHCARE
3051008085OTHERBLUE CROSS BLUE SHIELD
5630813275OTHERALCOMMERICIAL GRP
6630813275OTHERALWORK COMP
7MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8630813275OTHERALCHAMPUS

General Provider Information

NPI Number : 1639146889
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALONZO J MAHURIN PHD., D.O.
Provider Business Mailing Address
First Line : 4371 NARROW LANE RD
Second Line : SUITE 100
City : MONTGOMERY
State : AL
Zip : 36116-2971
Country : US
Telephone Number : 334-613-3680
Fax Number : 334-613-3685
Provider Business Practice Location Address
First Line : 4371 NARROW LANE RD
Second Line : SUITE 100
City : MONTGOMERY
State : AL
Zip : 36116-2971
Country : US
Telephone Number : 334-613-3680
Fax Number : 334-613-3685
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2006
Last Update Date : 04/09/2008

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