Provider Demographics
NPI:1811918469
Name:ALLEN, JODELL KAY (MD)
Entity type:Individual
Prefix:DR
First Name:JODELL
Middle Name:KAY
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4331 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4909
Mailing Address - Country:US
Mailing Address - Phone:904-731-2755
Mailing Address - Fax:904-731-7376
Practice Address - Street 1:1135 NW 23RD AVE
Practice Address - Street 2:SUITE N
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-5415
Practice Address - Country:US
Practice Address - Phone:352-378-9191
Practice Address - Fax:352-372-4823
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO37420207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80078729Medicaid