Provider Demographics
NPI:1063478493
Name:ALLEN, HENRY WILLIAM WEST IV (MD)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:WILLIAM WEST
Last Name:ALLEN
Suffix:IV
Gender:M
Credentials:MD
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Mailing Address - Street 1:623 N 9TH STREET
Mailing Address - Street 2:PO BOX 497
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006
Mailing Address - Country:US
Mailing Address - Phone:870-347-3300
Mailing Address - Fax:870-347-3492
Practice Address - Street 1:2816 FOX MEADOW LN
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9346
Practice Address - Country:US
Practice Address - Phone:870-336-1676
Practice Address - Fax:870-336-1679
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2013-11-08
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Provider Licenses
StateLicense IDTaxonomies
ARE4228207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100177820Medicaid
AR157593001Medicaid
KY7100177820Medicaid
AR57297Medicare PIN
I25714Medicare UPIN
AR5N055Medicare PIN