Provider Demographics
NPI:1366494700
Name:ALLAN, RICHMOND PRATER (MD)
Entity Type:Individual
Prefix:
First Name:RICHMOND
Middle Name:PRATER
Last Name:ALLAN
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 484
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29641-0484
Mailing Address - Country:US
Mailing Address - Phone:864-546-4497
Mailing Address - Fax:864-546-4506
Practice Address - Street 1:1330 BOILING SPRINGS RD
Practice Address - Street 2:SUITE 2100
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4201
Practice Address - Country:US
Practice Address - Phone:864-573-2145
Practice Address - Fax:864-573-2644
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23773207R00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC237737Medicaid
GAP00386918OtherMEDICARE RAILROAD PTAN #
SCSC1064Medicare UPIN
SC237737Medicaid
SC5878670017Medicare NSC
SCSC86956672Medicare UPIN
C491315286Medicare PIN
SCSC1064Medicare UPIN