Provider Demographics
NPI:1841271327
Name:ALLRED, PHILLIP L (AUD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:L
Last Name:ALLRED
Suffix:
Gender:M
Credentials:AUD
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 6073
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77342-6073
Mailing Address - Country:US
Mailing Address - Phone:936-291-2414
Mailing Address - Fax:936-438-8088
Practice Address - Street 1:1911 22ND ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4954
Practice Address - Country:US
Practice Address - Phone:936-291-2414
Practice Address - Fax:936-438-8088
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50104231H00000X
TX90002237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0223778-01Medicaid
TX8F2229Medicare PIN
TXR70269Medicare UPIN