Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD0000015065 | TN |
N | 207QA0401X | Family Doctor - Addiction Medicine | MD0000015065 | TN |
N | 207QA0505X | Family Doctor - Adult Medicine | MD0000015065 | TN |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD0000015065 | TN |
N | 207QS0010X | Family Doctor - Sports Medicine | MD0000015065 | TN |
N | 208D00000X | General Practice Physician | MD0000015065 | TN |
NPI | 1417142092 |
---|---|
Provider Name | Thomas G Allen |
First Address | Wartburg, TN 37887-4310 |
Second Address | Wartburg, TN 37887-4310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2007 |
Last Update Date | 01/09/2015 |