Basic Information
| Provider Information | |||||||||
| NPI: | 1174577225 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PINC | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2725 8TH STREET CT | ||||||||
| Address2: | |||||||||
| City: | MOLINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612655174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097927056 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 ILLINI DR | ||||||||
| Address2: | |||||||||
| City: | SILVIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612821804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097929363 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 03/09/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 036-104415 | IL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | H38603 | 01 | TRICARE | OTHER | 930110724 | 01 | RAILROAD MEDICARE | OTHER | H38603 | 01 | IL | BLUE CROSS BLUE SHIELD | OTHER | 98651 | 01 | IA | BLUE CROSS BLUE SHIELD | OTHER | 072074 | 01 | HEALTH ALLIANCE | OTHER |