Provider Demographics
NPI:1720208465
Name:HADDOCK, ALLEN HOUSTON (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:HOUSTON
Last Name:HADDOCK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4085 ALVAR DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-4404
Mailing Address - Country:US
Mailing Address - Phone:850-433-8471
Mailing Address - Fax:
Practice Address - Street 1:4600 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2337
Practice Address - Country:US
Practice Address - Phone:850-494-0048
Practice Address - Fax:850-494-0065
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2691902367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304351700Medicaid
FL304351700Medicaid