Provider Demographics
NPI:1447806625
Name:ALLEN, PETER LIAM (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:LIAM
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:38135 MARKET SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:352-567-0188
Mailing Address - Fax:813-355-5101
Practice Address - Street 1:1721 BRANDON MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5018
Practice Address - Country:US
Practice Address - Phone:813-973-1304
Practice Address - Fax:813-355-5024
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2022-08-25
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Provider Licenses
StateLicense IDTaxonomies
NY023851363A00000X
FLPA9115799363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant