Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 036085321 | IL |
Y | 207PP0204X | Pediatric Emergency Physician | 9500008 | NC |
NPI | 1396760666 |
---|---|
Provider Name | Gail Allen |
First Address | Charlotte, NC 28275-1069 |
Second Address | Greenville, NC 27834-2818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 30/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
126NA | BCBSNC (01) | NC |
89126NA | (05) | NC |