Healthcare Provider Details

I. General information

NPI: 1245258573
Provider Name (Legal Business Name): LELAND N. ALLEN III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 SAINT VINCENTS DR STE 300
BIRMINGHAM AL
35205-1612
US

IV. Provider business mailing address

833 SAINT VINCENTS DR STE 300
BIRMINGHAM AL
35205-1612
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-4640
  • Fax:
Mailing address:
  • Phone: 205-933-4640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number18247
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18247
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number18247
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: