Provider Demographics
NPI:1457342776
Name:LEIMENSTOLL, ALLEN J (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:J
Last Name:LEIMENSTOLL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:600 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-7211
Mailing Address - Country:US
Mailing Address - Phone:580-233-2300
Mailing Address - Fax:580-548-1489
Practice Address - Street 1:600 S MONROE ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-7211
Practice Address - Country:US
Practice Address - Phone:580-233-9310
Practice Address - Fax:580-548-1489
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200037520AMedicaid
OK249419505Medicare PIN