Provider Demographics
NPI:1780782797
Name:PALO, ALAN DOUGLAS BROWNFIELD (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DOUGLAS BROWNFIELD
Last Name:PALO
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 1:6611 PELHAM DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-4535
Mailing Address - Country:US
Mailing Address - Phone:440-888-5968
Mailing Address - Fax:
Practice Address - Street 1:6611 PELHAM DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-4535
Practice Address - Country:US
Practice Address - Phone:440-888-5968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3548442208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0536905Medicaid
OH0536905Medicaid
A15753Medicare UPIN