Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 22964 | KY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 22964 | KY |
NPI | 1497844765 |
---|---|
Provider Name | Dr. James Timothy Allen |
First Address | Louisville, KY 40206-2537 |
Second Address | Louisville, KY 40206-2537 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 14/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26197001 | MEDICARE PTAN (01) | IN |
C68637 | (02) | IN |