Basic Information
| Provider Information | |||||||||
| NPI: | 1457352478 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLAIS | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 N. 30TH ST | ||||||||
| Address2: | ADULT & GERIATRIC MEDICAL SPECIALTIES | ||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 82072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077426319 | ||||||||
| FaxNumber: | 3077426346 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 N. 30TH ST | ||||||||
| Address2: | ADULT & GERIATRIC MEDICAL SPECIALTIES | ||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 82072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077426319 | ||||||||
| FaxNumber: | 3077426346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 01/17/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5125A | WY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1039695 00 | 05 | WY | MEDICAID |