Provider Demographics
NPI:1013916816
Name:ALLEN II, HARRY S III (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:S
Last Name:ALLEN II
Suffix:III
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:PO BOX 2109
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29503-2109
Mailing Address - Country:US
Mailing Address - Phone:843-661-0500
Mailing Address - Fax:843-661-7370
Practice Address - Street 1:214 W PINE ST.
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4725
Practice Address - Country:US
Practice Address - Phone:843-661-0500
Practice Address - Fax:843-661-7370
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2018-09-24
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
SC7837207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC078374Medicaid
SC5259Medicare PIN
SC078374Medicaid