Provider Demographics
NPI:1063527455
Name:MCLEOD, ALAN J (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:J
Last Name:MCLEOD
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:PO BOX 5083
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-5083
Mailing Address - Country:US
Mailing Address - Phone:901-747-1000
Mailing Address - Fax:901-747-1001
Practice Address - Street 1:6019 WALNUT GROVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38159
Practice Address - Country:US
Practice Address - Phone:901-226-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN213152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3061383Medicaid
MS00010604Medicaid
TN130548OtherBCBS
AR95492OtherBCBS
MO203041918Medicaid
AR120531001Medicaid
TN3061383Medicaid
MO203041918Medicaid
TN300046969Medicare ID - Type UnspecifiedMEDICARE RR
AR120531001Medicaid