Provider Demographics
NPI:1477531283
Name:WAYNE, ALAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:J
Last Name:WAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 COUNTY ROAD 85
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:AL
Mailing Address - Zip Code:35772-5522
Mailing Address - Country:US
Mailing Address - Phone:256-437-2272
Mailing Address - Fax:256-437-2273
Practice Address - Street 1:196 COUNTY ROAD 85
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:AL
Practice Address - Zip Code:35772-5522
Practice Address - Country:US
Practice Address - Phone:256-437-2272
Practice Address - Fax:256-437-2273
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13785207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051521059OtherBCBS
AL009957765Medicaid
AL051521059Medicare ID - Type Unspecified
ALC72891Medicare UPIN