Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 26063 | SC |
NPI | 1063492494 |
---|---|
Provider Name | Todd Allen |
First Address | Walterboro, SC 29488-2710 |
Second Address | Dearborn, MI 48124-5032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 04/01/2022 |