Provider Demographics
NPI:1639159056
Name:ALLAN, SCOTT E (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:E
Last Name:ALLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:526 SHOUP AVE W
Mailing Address - Street 2:STE H
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5050
Mailing Address - Country:US
Mailing Address - Phone:208-733-2400
Mailing Address - Fax:208-734-0343
Practice Address - Street 1:526 SHOUP AVE W
Practice Address - Street 2:STE H
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5050
Practice Address - Country:US
Practice Address - Phone:208-733-2400
Practice Address - Fax:208-734-0343
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-5690207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1104280001Medicare NSC
D83682Medicare UPIN
1123542Medicare ID - Type Unspecified