Provider Demographics
NPI:1205008166
Name:JAMES F. ALLEN, MDPC
Entity Type:Organization
Organization Name:JAMES F. ALLEN, MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-789-4797
Mailing Address - Street 1:175 N 100 W STE 101
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2057
Mailing Address - Country:US
Mailing Address - Phone:435-789-4797
Mailing Address - Fax:435-789-4958
Practice Address - Street 1:175 N 100 W STE 101
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2057
Practice Address - Country:US
Practice Address - Phone:435-789-4797
Practice Address - Fax:435-789-4958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT70-151750-1205305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD99462Medicare UPIN