Provider Demographics
NPI:1255355996
Name:ALLEN, BERNAGIE E (MD)
Entity type:Individual
Prefix:
First Name:BERNAGIE
Middle Name:E
Last Name:ALLEN
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 1:1629 N RHONDA DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-2042
Mailing Address - Country:US
Mailing Address - Phone:479-251-1913
Mailing Address - Fax:
Practice Address - Street 1:100 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5311
Practice Address - Country:US
Practice Address - Phone:479-444-5016
Practice Address - Fax:479-587-5980
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC 8225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine