Provider Demographics
NPI:1477558245
Name:ALLING, JEFFERSON B (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:B
Last Name:ALLING
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 1:1001 W EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3745
Mailing Address - Country:US
Mailing Address - Phone:940-627-7443
Mailing Address - Fax:940-627-8326
Practice Address - Street 1:1001 W EAGLE DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3745
Practice Address - Country:US
Practice Address - Phone:940-627-7443
Practice Address - Fax:940-627-8326
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4125207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080081332OtherRAILROAD MEDICARE
TX130732401Medicaid
TX130732408Medicaid
TX130732401Medicaid
TX8E0102Medicare PIN