Provider Demographics
NPI:1306194188
Name:BRENT T ALFORD MD PA
Entity Type:Organization
Organization Name:BRENT T ALFORD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:T
Authorized Official - Last Name:ALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-663-4958
Mailing Address - Street 1:1356 OLD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-7642
Mailing Address - Country:US
Mailing Address - Phone:903-534-0809
Mailing Address - Fax:903-939-9149
Practice Address - Street 1:1356 OLD CREEK DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-7642
Practice Address - Country:US
Practice Address - Phone:903-534-0809
Practice Address - Fax:903-939-9149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1969207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty