Provider Demographics
NPI:1558587279
Name:ALAN W CARRUTH, MD PA
Entity Type:Organization
Organization Name:ALAN W CARRUTH, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CARRUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-668-7460
Mailing Address - Street 1:4605 OAK SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-7329
Mailing Address - Country:US
Mailing Address - Phone:972-668-7460
Mailing Address - Fax:972-668-7467
Practice Address - Street 1:4605 OAK SPRINGS DR
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-7329
Practice Address - Country:US
Practice Address - Phone:972-668-7460
Practice Address - Fax:972-668-7467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00078FMedicare ID - Type UnspecifiedGROUP #