Provider Demographics
NPI:1295840510
Name:ALABASTER, ALAN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:MICHAEL
Last Name:ALABASTER
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 1:1300 CENTERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4349
Mailing Address - Country:US
Mailing Address - Phone:501-410-1196
Mailing Address - Fax:501-410-1148
Practice Address - Street 1:995 S YATES RD
Practice Address - Street 2:STE. 1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0882
Practice Address - Country:US
Practice Address - Phone:901-527-7100
Practice Address - Fax:901-527-7124
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08478208800000X
ARR-3766208800000X
TN010710208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS340006063OtherMS RR MCR
MS00012171Medicaid
TN3191002Medicaid
TN340006061OtherTN RR MCR