Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | OS 003552L | PA |
NPI | 1235310079 |
---|---|
Provider Name | Robert B Allison |
First Address | Erie, PA 16510-2178 |
Second Address | Erie, PA 16510-2178 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2007 |
Last Update Date | 27/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000612505 | (05) | PA |
C31471 | (02) | PA |