Provider Demographics
NPI:1851490379
Name:PHILOGENE, ALLAIX (MD)
Entity Type:Individual
Prefix:
First Name:ALLAIX
Middle Name:
Last Name:PHILOGENE
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 1:606 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-3916
Mailing Address - Country:US
Mailing Address - Phone:561-996-3933
Mailing Address - Fax:561-996-3908
Practice Address - Street 1:606 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-3916
Practice Address - Country:US
Practice Address - Phone:561-996-3933
Practice Address - Fax:561-996-3908
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50445207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047031700Medicaid
FL047031700Medicaid
E60474Medicare UPIN