Basic Information
| Provider Information | |||||||||
| NPI: | 1609854405 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACINTYRE | ||||||||
| FirstName: | ALLAN | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12357 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309142357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068639595 | ||||||||
| FaxNumber: | 7068688375 | ||||||||
| Practice Location | |||||||||
| Address1: | 3186 S MARYLAND PKWY | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891092317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068639595 | ||||||||
| FaxNumber: | 7068688375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2006 | ||||||||
| LastUpdateDate: | 04/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0102X | OS15153 | FL | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | 1060 | NV | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | 86423 | GA | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | 4564 | TN | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | 1060 | NV | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
No ID Information.