MEDICARE: DR. GREGORY JOHN ALLEN M.D.

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
1	207Q00000X	Family Medicine Physician	L018162	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952398356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY JOHN ALLEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 129
Second Line	:
City	:	PONCHATOULA
State	:	LA
Zip	:	70454-0129
Country	:	US
Telephone Number	:	985-386-6198
Fax Number	:	985-386-6223

Provider Business Practice Location Address
First Line	:	105 E OAK ST
Second Line	:
City	:	PONCHATOULA
State	:	LA
Zip	:	70454-2619
Country	:	US
Telephone Number	:	985-386-6198
Fax Number	:	985-386-6223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	11/07/2008

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