Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 35-050640A | OH |
NPI | 1538278452 |
---|---|
Provider Name | David E Allen |
First Address | Pickerington, OH 43147-8451 |
Second Address | Gahanna, OH 43230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 30/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0612420 | (05) | OH |
E29617 | (02) |