Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 20A4992 | CA |
N | 2086S0120X | Pediatric Surgery | 31753 | CO |
Y | 2086S0120X | Pediatric Surgery | DO1571 | TN |
NPI | 1093809329 |
---|---|
Provider Name | Michael J Allshouse |
First Address | Mountain Home, TN 37684-0699 |
Second Address | Johnson City, TN 37604-6171 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 31/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01317536 | (05) | CO |
F48550 | (02) |