MEDICARE: MR. ALAN DAN SMITH RN

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	163W00000X	Registered Nurse	1-047643	AL

General Provider Information

NPI Number	:	1992892897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALAN DAN SMITH RN

Provider Business Mailing Address
First Line	:	14871 HIGHWAY 140
Second Line	:
City	:	COKER
State	:	AL
Zip	:	35452-3419
Country	:	US
Telephone Number	:	205-339-1156
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 57TH ST N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35217-3328
Country	:	US
Telephone Number	:	205-808-3377
Fax Number	:	205-808-3379

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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