Provider Demographics
NPI:1558559682
Name:ALLISON, JON DAVID (MD , MS)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:DAVID
Last Name:ALLISON
Suffix:
Gender:M
Credentials:MD , MS
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Other - Credentials:
Mailing Address - Street 1:3003 N CENTRAL AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2929
Mailing Address - Country:US
Mailing Address - Phone:602-685-6000
Mailing Address - Fax:602-302-7925
Practice Address - Street 1:8804 N 23RD AVE BLDG A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4160
Practice Address - Country:US
Practice Address - Phone:602-685-6000
Practice Address - Fax:602-216-7040
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ436032084P0800X
NYP600242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ570473Medicaid
AZZ182606Medicare PIN