Provider Demographics
NPI:1417992488
Name:ALLEN, PATRICIA A (DO)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1107 MEMORIAL DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8662
Mailing Address - Country:US
Mailing Address - Phone:706-277-7311
Mailing Address - Fax:706-272-3512
Practice Address - Street 1:1107 MEMORIAL DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8662
Practice Address - Country:US
Practice Address - Phone:706-277-7311
Practice Address - Fax:706-272-3512
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2045207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100184410AMedicaid
OK751465559003OtherBCBS
OK247609501Medicare PIN
OK751465559003OtherBCBS