Provider Demographics
NPI:1164459343
Name:JASON C ALLEN DPM PLLC
Entity Type:Organization
Organization Name:JASON C ALLEN DPM PLLC
Other - Org Name:CORNERSTONE PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:928-753-4500
Mailing Address - Street 1:1701 N STOCKTON HILL RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-6600
Mailing Address - Country:US
Mailing Address - Phone:928-753-4500
Mailing Address - Fax:928-753-2220
Practice Address - Street 1:1701 N STOCKTON HILL RD
Practice Address - Street 2:SUITE D
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-6600
Practice Address - Country:US
Practice Address - Phone:928-753-4500
Practice Address - Fax:928-753-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2014-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0641213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ094601Medicaid
AZZ109811Medicare PIN