Provider Demographics
NPI:1649297151
Name:ALLAN, JAMES WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
Last Name:ALLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 WEST LITTLE CANADA ROAD
Mailing Address - Street 2:
Mailing Address - City:LITTLE CANADA
Mailing Address - State:MN
Mailing Address - Zip Code:55117
Mailing Address - Country:US
Mailing Address - Phone:651-481-1119
Mailing Address - Fax:651-481-1476
Practice Address - Street 1:75 WEST LITTLE CANADA ROAD
Practice Address - Street 2:
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55117
Practice Address - Country:US
Practice Address - Phone:651-481-1119
Practice Address - Fax:651-481-1476
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN20780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
20504LIOtherBCBS
0123164OtherMEDICA
MN263273000Medicaid
20504LIOtherBCBS
MN263273000Medicaid