Provider Demographics
NPI:1417051962
Name:WESTON, ALLAN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:PAUL
Last Name:WESTON
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 1:2900 MEDICAL CENTER PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3214
Mailing Address - Country:US
Mailing Address - Phone:620-783-1650
Mailing Address - Fax:620-783-1652
Practice Address - Street 1:198 FOUR STATES DR
Practice Address - Street 2:SUITE 6
Practice Address - City:GALENA
Practice Address - State:KS
Practice Address - Zip Code:66739-4304
Practice Address - Country:US
Practice Address - Phone:620-783-1650
Practice Address - Fax:620-783-1652
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2004012778207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208658419Medicaid
KS100279270BMedicaid
P00344310OtherRR MEDICARE
OK200095440AMedicaid
MO214248OtherANTHEM
G43014Medicare UPIN
MO208658419Medicaid