Provider Demographics
NPI:1689658908
Name:GERMAINE, ALLEN MAX JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:MAX
Last Name:GERMAINE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:2345 E SOUTHERN AVE
Mailing Address - Street 2:#101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5417
Mailing Address - Country:US
Mailing Address - Phone:480-893-2345
Mailing Address - Fax:480-926-0495
Practice Address - Street 1:2345 E SOUTHERN AVE
Practice Address - Street 2:#101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5417
Practice Address - Country:US
Practice Address - Phone:480-893-2345
Practice Address - Fax:480-926-0495
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2014-11-18
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Provider Licenses
StateLicense IDTaxonomies
AZ15647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ274796Medicaid
AZZ108141OtherPTAN
AZ02WCFCX01Medicare ID - Type Unspecified
D36902Medicare UPIN