Provider Demographics
NPI:1619062130
Name:ALLRAN, CHARLES F JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:F
Last Name:ALLRAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1210 KY HIGHWAY 36 E
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-7490
Mailing Address - Country:US
Mailing Address - Phone:859-234-1707
Mailing Address - Fax:859-234-1768
Practice Address - Street 1:1210 KY HIGHWAY 36 E
Practice Address - Street 2:SUITE 1D
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-7490
Practice Address - Country:US
Practice Address - Phone:859-234-1707
Practice Address - Fax:859-234-1768
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY33182208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64056369Medicaid
H69940Medicare UPIN
H69940Medicare UPIN