Provider Demographics
NPI:1558302893
Name:ALLYN, DONALD LANCY (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LANCY
Last Name:ALLYN
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 1:1010 W GRANGEVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-2720
Mailing Address - Country:US
Mailing Address - Phone:559-584-3000
Mailing Address - Fax:
Practice Address - Street 1:125 MALL DR.
Practice Address - Street 2:SUITE 301
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230
Practice Address - Country:US
Practice Address - Phone:559-584-3000
Practice Address - Fax:559-583-8456
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21696174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G216960Medicaid
CA00G216960Medicaid
CA00G216960Medicare PIN