Provider Demographics
NPI:1225019706
Name:DISHUCK, JOHN FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRANK
Last Name:DISHUCK
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 1:535 JACK WARNER PKWY NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-5751
Mailing Address - Country:US
Mailing Address - Phone:205-553-2252
Mailing Address - Fax:205-553-3326
Practice Address - Street 1:535 JACK WARNER PKWY NE
Practice Address - Street 2:SUITE C
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5751
Practice Address - Country:US
Practice Address - Phone:205-553-2252
Practice Address - Fax:205-553-3326
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12867207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51083745OtherBC/BS ALABAMA
AL83745Medicaid
83745Medicare ID - Type Unspecified
AL83745Medicaid