Provider Demographics
NPI:1639146889
Name:MAHURIN, ALONZO J (PHD, DO)
Entity Type:Individual
Prefix:DR
First Name:ALONZO
Middle Name:J
Last Name:MAHURIN
Suffix:
Gender:M
Credentials:PHD, DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4371 NARROW LANE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2971
Mailing Address - Country:US
Mailing Address - Phone:334-613-3680
Mailing Address - Fax:334-613-3685
Practice Address - Street 1:4371 NARROW LANE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2971
Practice Address - Country:US
Practice Address - Phone:334-613-3680
Practice Address - Fax:334-613-3685
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630813275OtherCOMMERCIAL PRV
AL01 11606OtherUNITED HEALTHCARE
051008085OtherBLUE CROSS BLUE SHIELD
AL080141135OtherRAILROAD MEDICARE
AL630813275OtherCOMMERICIAL GRP
AL630813275OtherWORK COMP
AL000008085Medicaid
AL630813275OtherCHAMPUS
AL000008085Medicaid
000008085Medicare ID - Type Unspecified