Provider Demographics
NPI:1689614281
Name:NORD, ALLEN
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:NORD
Suffix:
Gender:M
Credentials:
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 6020
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-6020
Mailing Address - Country:US
Mailing Address - Phone:605-342-3280
Mailing Address - Fax:605-721-8438
Practice Address - Street 1:717 SAINT FRANCIS ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4677
Practice Address - Country:US
Practice Address - Phone:605-342-2880
Practice Address - Fax:605-388-4621
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2528207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD080169993OtherRR MEDICARE
SD0008011OtherBCBS
SD5600576Medicaid
SD8011Medicare ID - Type Unspecified
SDS107553Medicare PIN
SD080169993OtherRR MEDICARE
SD8011Medicare PIN