Provider Demographics
NPI:1720770993
Name:SELPH, ALLAN BRENT JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:BRENT
Last Name:SELPH
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 100286
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0286
Mailing Address - Country:US
Mailing Address - Phone:352-265-0761
Mailing Address - Fax:352-265-1060
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-5282
Practice Address - Country:US
Practice Address - Phone:352-265-0761
Practice Address - Fax:352-265-1060
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-07-24
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Provider Licenses
StateLicense IDTaxonomies
FLPA9117675363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant