Provider Demographics
NPI:1578749776
Name:ALLISON, HOWARD H (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:H
Last Name:ALLISON
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 1:500 W EATON AVE
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3422
Mailing Address - Country:US
Mailing Address - Phone:209-832-3222
Mailing Address - Fax:209-832-7610
Practice Address - Street 1:500 W EATON AVE
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3422
Practice Address - Country:US
Practice Address - Phone:209-832-3222
Practice Address - Fax:209-832-7610
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51865207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G518650Medicaid
CA00G518650Medicare PIN
CAA52102Medicare UPIN