1720020795 NPI number — DR. ELBERT ALAN DUNCAN M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720020795 NPI number — DR. ELBERT ALAN DUNCAN M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DUNCAN

Provider First Name:

ELBERT

Provider Middle Name:

ALAN

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1720020795

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/30/2015

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2000A SOUTHBRIDGE PKWY

Provider Second Line Business Mailing Address:

STE 300

Provider Business Mailing Address City Name:

BIRMINGHAM

Provider Business Mailing Address State Name:

AL

Provider Business Mailing Address Postal Code:

35209-7718

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

205-871-4274

Provider Business Mailing Address Fax Number:

205-871-4301

Provider First Line Business Practice Location Address:

990 SOUTH MADISON STREET

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

TUPELO

Provider Business Practice Location Address State Name:

MS

Provider Business Practice Location Address Postal Code:

38801-6308

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

662-620-7101

Provider Business Practice Location Address Fax Number:

662-842-1457

Provider Enumeration Date:

06/12/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0001X , with the licence number:  11616 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 00017748 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
• Identifier: 144586 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 144351 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 144391 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 511-30495 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 009700300 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 300001093 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 300125168 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
• Identifier: 511-30494 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 511-55489 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 166717 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 511-30486 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".