Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 4756 | AL |
NPI | 1225003171 |
---|---|
Provider Name | Dr. Roger D Allen |
First Address | Gadsden, AL 35901-5101 |
Second Address | Gadsden, AL 35901-5101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
21930 | BLUE CROSS PROVIDER (01) | AL |
89371 | (02) | AL |