Basic Information
| Provider Information | |||||||||
| NPI: | 1063527455 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCLEOD | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5083 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381015083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017471000 | ||||||||
| FaxNumber: | 9017471001 | ||||||||
| Practice Location | |||||||||
| Address1: | 6019 WALNUT GROVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012265000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 08/30/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 21315 | TN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 3061383 | 05 | TN | MEDICAID | 00010604 | 05 | MS | MEDICAID | 130548 | 01 | TN | BCBS | OTHER | 95492 | 01 | AR | BCBS | OTHER | 203041918 | 05 | MO | MEDICAID | 120531001 | 05 | AR | MEDICAID |