Provider Demographics
NPI:1164425856
Name:ALLEY, PAUL DEMING (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DEMING
Last Name:ALLEY
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 1:1150 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-1071
Mailing Address - Country:US
Mailing Address - Phone:812-424-9291
Mailing Address - Fax:812-421-2722
Practice Address - Street 1:1150 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-1071
Practice Address - Country:US
Practice Address - Phone:812-402-4263
Practice Address - Fax:812-437-4263
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045400A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100373770Medicaid
IN000000198998OtherANTHEM BCBS
IN0231480001OtherMEDICARE DME
IN847950NMedicare ID - Type Unspecified
IN000000198998OtherANTHEM BCBS