Provider Demographics
NPI:1659362317
Name:ALLEN, JOHN CHRISTOPHER (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16026 DOCTOR'S BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403
Mailing Address - Country:US
Mailing Address - Phone:985-340-0099
Mailing Address - Fax:985-340-1130
Practice Address - Street 1:16026 DOCTOR'S BOULEVARD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403
Practice Address - Country:US
Practice Address - Phone:985-340-0099
Practice Address - Fax:985-340-1130
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD315R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1156744Medicaid
LA1156744Medicaid
U95267Medicare UPIN