Provider Demographics
NPI:1225055999
Name:DVORAK, ALLEN D (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:D
Last Name:DVORAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 EAST GOLD COAST RD
Mailing Address - Street 2:STE 102
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4782
Mailing Address - Country:US
Mailing Address - Phone:402-339-8991
Mailing Address - Fax:402-339-6741
Practice Address - Street 1:401 EAST GOLD COAST RD
Practice Address - Street 2:STE 102
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4782
Practice Address - Country:US
Practice Address - Phone:402-339-8991
Practice Address - Fax:402-339-6741
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE120452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE300010990Medicare PIN
NEC50206Medicare PIN
NE088538Medicare PIN
IA300049346Medicare PIN
IA32885Medicare PIN
IACJ3861Medicare PIN
E29179Medicare UPIN