Individual
DR. ALAN BART MICKISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
400 W PLUMMER, EASTLAND, TX 76448
(254) 629-1744
(254) 629-3904
Mailing address
PO BOX 1429, EASTLAND, TX 76448-1429
(254) 629-1744
(254) 629-3904
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E1059
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1210627-01
—
TX
Enumeration date
08/29/2006
Last updated
10/26/2020
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