Provider Demographics
NPI:1912955824
Name:ALLEN, WILLIAM M (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 16871
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-6714
Mailing Address - Country:US
Mailing Address - Phone:479-273-9700
Mailing Address - Fax:479-273-9706
Practice Address - Street 1:701 HORSEBARN ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758
Practice Address - Country:US
Practice Address - Phone:479-273-9700
Practice Address - Fax:479-273-9706
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARR3669207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR112321001Medicaid
AR112321001Medicaid
AR50402Medicare ID - Type Unspecified