Basic Information
| Provider Information | |||||||||
| NPI: | 1962513705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLISON | ||||||||
| FirstName: | JEFFERY | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | 2565394099 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | 2565394099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 04/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 24810 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 24810 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 24810 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 102305 | 05 | AL | MEDICAID | 112551 | 05 | AL | MEDICAID | 009998235 | 05 | AL | MEDICAID | 51598970 | 01 | AL | BCBS | OTHER | 7757751 | 01 | AETNA | OTHER | P00770862 | 01 | AL | RAILROAD MEDICARE | OTHER | 112583 | 05 | AL | MEDICAID | 51049215 | 01 | AL | BCBS | OTHER | 51049214 | 01 | AL | BCBS | OTHER | 51049216 | 01 | AL | BCBS | OTHER | 51598971 | 01 | AL | BCBS | OTHER | 112555 | 05 | AL | MEDICAID | 112565 | 05 | AL | MEDICAID | 51547760 | 01 | AL | BCBS | OTHER | 112571 | 05 | AL | MEDICAID | 51049217 | 01 | AL | BCBS | OTHER | 112578 | 05 | AL | MEDICAID |