Provider Demographics
NPI:1467496307
Name:ALLEN, JEFFERY L (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 DILLOWAY DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6770
Mailing Address - Country:US
Mailing Address - Phone:989-631-2889
Mailing Address - Fax:989-488-4475
Practice Address - Street 1:4005 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48670-0001
Practice Address - Country:US
Practice Address - Phone:989-839-3100
Practice Address - Fax:989-839-1393
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301047735207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1797226Medicaid
MI1797226Medicaid
MIB46118Medicare UPIN