Provider Demographics
NPI:1134124969
Name:GIROUARD, ALLAIN A (MD)
Entity Type:Individual
Prefix:
First Name:ALLAIN
Middle Name:A
Last Name:GIROUARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6061 ST JOHNS AVENUE, SUITE 1
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177
Mailing Address - Country:US
Mailing Address - Phone:386-530-2953
Mailing Address - Fax:386-385-3597
Practice Address - Street 1:6061 ST JOHNS AVENUE, SUITE 1
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177
Practice Address - Country:US
Practice Address - Phone:386-530-2953
Practice Address - Fax:386-385-3597
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2018-03-15
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
FLME76714207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
249068OtherAVMED
FL5893649OtherAETNA
FL44394OtherBCBS OF FLORIDA
FL0599777OtherGHI
FLG72635Medicare UPIN
249068OtherAVMED
FL5649050001Medicare NSC
FL0599777OtherGHI