Provider Demographics
NPI:1093829392
Name:ALLEY, JOANN (MD)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:ALLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4864 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-6400
Mailing Address - Country:US
Mailing Address - Phone:318-330-7655
Mailing Address - Fax:318-330-7649
Practice Address - Street 1:4864 JACKSON ST
Practice Address - Street 2:DEPARTMENT OF SURGERY
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-6400
Practice Address - Country:US
Practice Address - Phone:318-330-7655
Practice Address - Fax:318-330-7649
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017799208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1907928Medicaid
LAE65680Medicare UPIN
LA5N339Medicare PIN