Provider Demographics
NPI:1457352478
Name:ALLAIS, JEAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:M
Last Name:ALLAIS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:255 N. 30TH ST
Mailing Address - Street 2:ADULT & GERIATRIC MEDICAL SPECIALTIES
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072
Mailing Address - Country:US
Mailing Address - Phone:307-742-6319
Mailing Address - Fax:307-742-6346
Practice Address - Street 1:255 N. 30TH ST
Practice Address - Street 2:ADULT & GERIATRIC MEDICAL SPECIALTIES
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072
Practice Address - Country:US
Practice Address - Phone:307-742-6319
Practice Address - Fax:307-742-6346
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2013-01-17
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Provider Licenses
StateLicense IDTaxonomies
WY5125A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1039695 00Medicaid
WYA03625Medicare UPIN