Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 4550 341 | KY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 4550 | KY |
NPI | 1134283765 |
---|---|
Provider Name | Dr. Mark S Allen |
First Address | Bowling Green, KY 42104-3366 |
Second Address | Bowling Green, KY 42104-3366 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 14/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60045507 | (05) | KY |
64045503 | (05) | KY |
T54071 | (02) | KY |