Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | G25063 | CA |
N | 2086S0122X | Plastic and Reconstructive Surgery | G25063 | CA |
N | 2086X0206X | Surgical Oncologist | G25063 | CA |
NPI | 1245386051 |
---|---|
Provider Name | Dr. Glenn Roy Allison |
First Address | Tustin, CA 92781-3057 |
Second Address | Orange, CA 92866-1506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A42505 | (02) | CA |