Provider Demographics
NPI:1376885269
Name:DAVID, ALLAN EVERETT (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:EVERETT
Last Name:DAVID
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 1:5 CORONA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-5704
Mailing Address - Country:US
Mailing Address - Phone:949-854-9234
Mailing Address - Fax:
Practice Address - Street 1:5 CORONA
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603-5704
Practice Address - Country:US
Practice Address - Phone:949-854-9234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30578207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0062680Medicaid
CAA44473Medicare UPIN