Provider Demographics
NPI:1447231717
Name:ALLEN, JAY (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:ALLEN
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 1:3011 N MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-2546
Mailing Address - Country:US
Mailing Address - Phone:620-240-5668
Mailing Address - Fax:620-240-4353
Practice Address - Street 1:302 N 1ST ST
Practice Address - Street 2:
Practice Address - City:MOUND CITY
Practice Address - State:KS
Practice Address - Zip Code:66056-5279
Practice Address - Country:US
Practice Address - Phone:913-795-8302
Practice Address - Fax:913-795-8002
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-25875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100185400BMedicaid
KSBS051662Medicare ID - Type Unspecified
KS100185400BMedicaid