Provider Demographics
NPI:1013238419
Name:NANNEY, ALLAN DOUGLAS III (MD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:DOUGLAS
Last Name:NANNEY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6653 LOOKOUT RD # A103
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3362
Mailing Address - Country:US
Mailing Address - Phone:704-519-9162
Mailing Address - Fax:
Practice Address - Street 1:2222 N NEVADA AVE STE 5001
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6865
Practice Address - Country:US
Practice Address - Phone:719-776-3580
Practice Address - Fax:719-776-3599
Is Sole Proprietor?:No
Enumeration Date:2010-06-20
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125055764207T00000X
CODR.0056991207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49200062Medicaid