Provider Demographics
NPI:1174220321
Name:AUSTIN, ALEC MICHAEL
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:MICHAEL
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:IA
Mailing Address - Zip Code:52747-7737
Mailing Address - Country:US
Mailing Address - Phone:563-785-4487
Mailing Address - Fax:563-785-6681
Practice Address - Street 1:619 5TH ST
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:IA
Practice Address - Zip Code:52747-7737
Practice Address - Country:US
Practice Address - Phone:563-785-4487
Practice Address - Fax:563-785-6681
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA173106363L00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine