Provider Demographics
NPI:1073592812
Name:ALLEN, JAMES K (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:K
Last Name:ALLEN
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 490940
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-0940
Mailing Address - Country:US
Mailing Address - Phone:352-460-0292
Mailing Address - Fax:352-460-0785
Practice Address - Street 1:120 E NORTH BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5241
Practice Address - Country:US
Practice Address - Phone:352-460-0292
Practice Address - Fax:352-460-0785
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77897207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256669900Medicaid
FL256669900Medicaid
FL46974YMedicare PIN
FL46974ZMedicare PIN
FL46974XMedicare PIN