Provider Demographics
NPI:1679598775
Name:ALLEN, CLINTON JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:JOSEPH
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CENTRE
Mailing Address - State:AL
Mailing Address - Zip Code:35960-1022
Mailing Address - Country:US
Mailing Address - Phone:256-927-3607
Mailing Address - Fax:256-927-3606
Practice Address - Street 1:401 NORTHWOOD DR
Practice Address - Street 2:
Practice Address - City:CENTRE
Practice Address - State:AL
Practice Address - Zip Code:35960-1022
Practice Address - Country:US
Practice Address - Phone:256-927-3607
Practice Address - Fax:256-927-3606
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25463207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009996745Medicaid
AL51001409OtherBLUE CROSS BLUE SHIELD
AL51001409OtherBLUE CROSS BLUE SHIELD
AL009996745Medicaid