Provider Demographics
NPI:1437144904
Name:ALLEN, STEPHEN C (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:ALLEN
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 1:425 W 3RD AVE
Mailing Address - Street 2:SUITE 550
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1941
Mailing Address - Country:US
Mailing Address - Phone:229-432-8463
Mailing Address - Fax:229-432-8465
Practice Address - Street 1:425 W 3RD AVE
Practice Address - Street 2:SUITE 550
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1941
Practice Address - Country:US
Practice Address - Phone:229-432-8463
Practice Address - Fax:229-432-8465
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAD44699208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00306112OtherRAILROAD MEDICARE
GAD44699Medicare UPIN
GAP00306112OtherRAILROAD MEDICARE