Provider Demographics
NPI:1174577225
Name:PINC, ALEXANDER DAVID (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:DAVID
Last Name:PINC
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 1:2725 8TH STREET CT
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-5174
Mailing Address - Country:US
Mailing Address - Phone:309-792-7056
Mailing Address - Fax:
Practice Address - Street 1:801 ILLINI DR
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-1804
Practice Address - Country:US
Practice Address - Phone:309-792-9363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-104415207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H38603OtherTRICARE
930110724OtherRAILROAD MEDICARE
ILH38603OtherBLUE CROSS BLUE SHIELD
IA98651OtherBLUE CROSS BLUE SHIELD
072074OtherHEALTH ALLIANCE
ILK30931Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
IA98651OtherBLUE CROSS BLUE SHIELD
ILH38603OtherBLUE CROSS BLUE SHIELD
ILP00664168Medicare PIN