Provider Demographics
NPI:1225065022
Name:DOCTORS MED CARE OF FORT PAYNE, P.C.
Entity Type:Organization
Organization Name:DOCTORS MED CARE OF FORT PAYNE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRANAV
Authorized Official - Middle Name:K
Authorized Official - Last Name:MISHRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-845-6900
Mailing Address - Street 1:1040 GLENN BLVD SW
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967-8413
Mailing Address - Country:US
Mailing Address - Phone:256-845-6900
Mailing Address - Fax:256-845-6905
Practice Address - Street 1:1040 GLENN BLVD SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-8413
Practice Address - Country:US
Practice Address - Phone:256-845-6900
Practice Address - Fax:256-845-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty