Basic Information
| Provider Information | |||||||||
| NPI: | 1811915275 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLMAN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | KIRK | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8475 E HARTFORD DR STE 201 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852555477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805919345 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4700 JEFFERSON ST NE STE 800 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871092132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059327112 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 08/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 95PA23 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | H2827 | 05 | NM | MEDICAID |