Provider Demographics
NPI:1841458668
Name:CHAN, ALLISON CULBRETH (MD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:CULBRETH
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:LEIGH
Other - Last Name:CULBRETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:1731 WELLS RD STE 120
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2322
Practice Address - Country:US
Practice Address - Phone:904-376-4910
Practice Address - Fax:904-390-7547
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111797208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004421900Medicaid
FL14J6SOtherBCBS-FL
FL004421900Medicaid