Provider Demographics
NPI:1588629463
Name:ALLNUTT, JOHN FRANKLIN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FRANKLIN
Last Name:ALLNUTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JACK
Other - Middle Name:FRANKLIN
Other - Last Name:ALLNUTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5290 MADISON PIKE
Mailing Address - Street 2:STE 100
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051
Mailing Address - Country:US
Mailing Address - Phone:859-363-8600
Mailing Address - Fax:859-960-0003
Practice Address - Street 1:5290 MADISON PIKE
Practice Address - Street 2:STE 100
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051
Practice Address - Country:US
Practice Address - Phone:859-363-8600
Practice Address - Fax:859-960-0003
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000370204OtherANTHEM
000000370204OtherANTHEM
C70711Medicare UPIN