Provider Demographics
NPI:1548565773
Name:DESTIN ORTHOPEDICS,PL
Entity Type:Organization
Organization Name:DESTIN ORTHOPEDICS,PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:251-665-5127
Mailing Address - Street 1:36008 EMERALD COAST PKWY
Mailing Address - Street 2:SUITE 102A
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-4792
Mailing Address - Country:US
Mailing Address - Phone:251-665-5127
Mailing Address - Fax:251-665-5159
Practice Address - Street 1:5613 COTTAGE HILL RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-4210
Practice Address - Country:US
Practice Address - Phone:251-665-5127
Practice Address - Fax:251-665-5159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD9362207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000026765Medicare PIN
C75293Medicare UPIN