Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | P-143 | ID |
NPI | 1093717787 |
---|---|
Provider Name | Dr. Richard Michael Allen |
First Address | Lewiston, ID 83501-6350 |
Second Address | Lewiston, ID 83501-6350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 07/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000010015686 | REGENCE BLUESHIELD OF ID (01) | ID |
0027887 | (05) | ID |
P9186 | BLUE CROSS OF IDAHO (01) | ID |
U20751 | (02) | ID |