Provider Demographics
NPI:1184015182
Name:MARKOVIC, ALLEN (PA-C)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:MARKOVIC
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 CEDAR RAVINE RD
Mailing Address - Street 2:STE 201
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6561
Mailing Address - Country:US
Mailing Address - Phone:530-626-1602
Mailing Address - Fax:
Practice Address - Street 1:3301 C ST STE 1300
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3370
Practice Address - Country:US
Practice Address - Phone:916-734-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0004463363A00000X
NVPA1587363A00000X
CAPA54387363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant