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NPI Code Detail

MEDICARE: JUSTIN THOMAS ALLEN PA

MEDICARE: JUSTIN THOMAS ALLEN PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant313415LA

General Provider Information

NPI Number : 1871154229
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN THOMAS ALLEN PA
Provider Business Mailing Address
First Line : 7777 HENNESSY BLVD STE 1008
Second Line :
City : BATON ROUGE
State : LA
Zip : 70808-4368
Country : US
Telephone Number : 225-766-0416
Fax Number : 225-769-9212
Provider Business Practice Location Address
First Line : 7777 HENNESSY BLVD STE 1008
Second Line :
City : BATON ROUGE
State : LA
Zip : 70808-4368
Country : US
Telephone Number : 225-766-0416
Fax Number : 225-769-9212
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2019
Last Update Date : 07/24/2023

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1992162515 — SAMANTHA TIBLIER NP
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Directions to “ JUSTIN THOMAS ALLEN PA” Practice Location

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