Basic Information
Provider Information | |||||||||
NPI: | 1558330902 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ALLEN | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | MADISON | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ALLEN | ||||||||
OtherFirstName: | JAMES | ||||||||
OtherMiddleName: | M | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 2147 RIVERCHASE OFFICE RD | ||||||||
Address2: | MSC 10000020 | ||||||||
City: | BIRMINGHAM | ||||||||
State: | AL | ||||||||
PostalCode: | 352441836 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2054038902 | ||||||||
FaxNumber: | 2059820278 | ||||||||
Practice Location | |||||||||
Address1: | 1680 MONTGOMERY HWY | ||||||||
Address2: |   | ||||||||
City: | HOOVER | ||||||||
State: | AL | ||||||||
PostalCode: | 352164906 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2059790888 | ||||||||
FaxNumber: | 2059794110 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/17/2006 | ||||||||
LastUpdateDate: | 09/20/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 9674 | AL | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 080136180 | 01 | AL | RAILROAD MEDICARE | OTHER | 051526738 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER | 009933057 | 05 | AL |   | MEDICAID |