Basic Information
| Provider Information | |||||||||
| NPI: | 1780828871 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLERGY AND ASTHMA CLINIC, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16475 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275166475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199676646 | ||||||||
| FaxNumber: | 9199676647 | ||||||||
| Practice Location | |||||||||
| Address1: | 2312 KENTUCKY AVE | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420033244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704425151 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2009 | ||||||||
| LastUpdateDate: | 04/21/2009 | ||||||||
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| AuthorizedOfficialLastName: | RANKIN | ||||||||
| AuthorizedOfficialFirstName: | BRADLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2704425151 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207KA0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy |
No ID Information.