Provider Demographics
NPI:1629273578
Name:KARIN PARDUE MD LLC
Entity Type:Organization
Organization Name:KARIN PARDUE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARDUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-981-8713
Mailing Address - Street 1:PO BOX 838
Mailing Address - Street 2:
Mailing Address - City:ELBERTA
Mailing Address - State:AL
Mailing Address - Zip Code:36530-0838
Mailing Address - Country:US
Mailing Address - Phone:251-981-8713
Mailing Address - Fax:251-974-3027
Practice Address - Street 1:4223 ORANGE BEACH BL
Practice Address - Street 2:SUITE A
Practice Address - City:ORANGE BEACH
Practice Address - State:AL
Practice Address - Zip Code:36561-3459
Practice Address - Country:US
Practice Address - Phone:251-981-8713
Practice Address - Fax:251-974-3027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207Q00000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00141834OtherMEDICARE RAILROAD
AL51518970PAROtherBLUE CROSS
ALP00141834OtherMEDICARE RAILROAD
ALH06582Medicare UPIN