Basic Information
| Provider Information | |||||||||
| NPI: | 1760474423 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 157 PROFESSIONAL PARK DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281175605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046623967 | ||||||||
| FaxNumber: | 7046623975 | ||||||||
| Practice Location | |||||||||
| Address1: | 157 PROFESSIONAL PARK DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281175605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046623967 | ||||||||
| FaxNumber: | 7046623975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 09/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 200100116 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8912990 | 05 | NC | MEDICAID |