Provider Demographics
NPI:1558463489
Name:ALFORD, GLEN ERNEST (MD)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:ERNEST
Last Name:ALFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:146 HOLLOWVIEW DR
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-0239
Mailing Address - Country:US
Mailing Address - Phone:336-667-8228
Mailing Address - Fax:336-667-2899
Practice Address - Street 1:1016 FLETCHER ST
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-9472
Practice Address - Country:US
Practice Address - Phone:336-667-8228
Practice Address - Fax:336-667-2899
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905020Medicaid
NC2329295OtherMEDICARE GROUP
NC2329295OtherMEDICARE GROUP
NC5905020Medicaid