Provider Demographics
NPI:1316003098
Name:ALLEGA, ROHN S (MD)
Entity Type:Individual
Prefix:DR
First Name:ROHN
Middle Name:S
Last Name:ALLEGA
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:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-2273
Mailing Address - Fax:
Practice Address - Street 1:1130 E 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4034
Practice Address - Country:US
Practice Address - Phone:417-347-2273
Practice Address - Fax:417-347-2277
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2206207Q00000X
SC36359207Q00000X
IL036117506207Q00000X
MO2019018019207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX635487YM5UOtherMEDICARE PIN
SC363592Medicaid
TX118563905Medicaid