Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 8471 | KY |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 8471 | KY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 8471 | KY |
NPI | 1093945560 |
---|---|
Provider Name | Dr. William R. Allen JR. |
First Address | Louisville, KY 40205 |
Second Address | Louisville, KY 40202-1882 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2009 |
Last Update Date | 12/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000770334 | ANTHEM (01) | KY |
201098860 | (05) | IN |
7100210090 | (05) | KY |
7100210290 | (05) | KY |
P01500682 | RAILROAD MEDICARE (01) | KY |