Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | O-1278 | ID |
Y | 111NI0900X | Internist | O-1278 | ID |
NPI | 1003261108 |
---|---|
Provider Name | Shawn Allman |
First Address | Pocatello, ID 83201-5175 |
Second Address | Pocatello, ID 83201-5175 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2016 |
Last Update Date | 15/08/2019 |