Provider Demographics
NPI:1235310079
Name:ALLISON, ROBERT B (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:ALLISON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4234 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-2178
Mailing Address - Country:US
Mailing Address - Phone:814-899-0691
Mailing Address - Fax:814-899-6260
Practice Address - Street 1:4234 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-2178
Practice Address - Country:US
Practice Address - Phone:814-899-0691
Practice Address - Fax:814-899-6260
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 003552L207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000612505Medicaid
PAC31471Medicare UPIN
PA000612505Medicaid