Provider Demographics
NPI:1548285182
Name:CULBRETH, ALAN P (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:P
Last Name:CULBRETH
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 189
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-0189
Mailing Address - Country:US
Mailing Address - Phone:812-273-7700
Mailing Address - Fax:812-273-2827
Practice Address - Street 1:445 CLIFTY DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-1607
Practice Address - Country:US
Practice Address - Phone:812-273-7700
Practice Address - Fax:812-273-2827
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000042215OtherANTHEM BCBS
265769OtherFEDERAL BLACK LUNG
KY64210115Medicaid
IN100148970AMedicaid
080100603OtherMEDICARE RAILROAD
4370929OtherAETNA
IN410016POtherSIHO
IN410016POtherSIHO
4370929OtherAETNA
265769OtherFEDERAL BLACK LUNG
IN080100603Medicare PIN