Provider Demographics
NPI:1619990033
Name:STRUTH, ALAN GADSON (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:GADSON
Last Name:STRUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2405
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31099-2405
Mailing Address - Country:US
Mailing Address - Phone:478-922-0233
Mailing Address - Fax:478-929-4045
Practice Address - Street 1:1037 N HOUSTON RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-1505
Practice Address - Country:US
Practice Address - Phone:478-922-0233
Practice Address - Fax:478-929-4045
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019110207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000153623AMedicaid
GAD41187Medicare UPIN