Provider Demographics
NPI:1609854405
Name:MACINTYRE, ALLAN DAVID (DO)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:DAVID
Last Name:MACINTYRE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100744
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2357
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3196 S MARYLAND PKWY STE 425
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2318
Practice Address - Country:US
Practice Address - Phone:725-205-0725
Practice Address - Fax:725-204-5251
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1060208600000X, 2086S0102X
FLOS151532086S0102X
GA864232086S0102X
TN45642086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018582Medicaid
MO207012808Medicaid
NVCS11247OtherPHARMACY/CDS
MO207012808Medicaid
NV002018582Medicaid
NVH21587Medicare UPIN
NVCS11247OtherPHARMACY/CDS
NVWQBHV36508Medicare ID - Type Unspecified