Provider Demographics
NPI:1003132887
Name:ALLISON, NATHAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:D
Last Name:ALLISON
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 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-9230
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:8725 N WICKHAM RD
Practice Address - Street 2:SUITE 302
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2239
Practice Address - Country:US
Practice Address - Phone:321-434-9230
Practice Address - Fax:321-434-9231
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109885207RB0002X, 208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFF615YOtherMEDICARE
FL117593000Medicaid