Healthcare Provider Details

I. General information

NPI: 1013969161
Provider Name (Legal Business Name): ALLISON JAMES BOTWIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 S FARRELL DR SUITE A-206
PALM SPRINGS CA
92262-7963
US

IV. Provider business mailing address

340 S FARRELL DR SUITE A-206
PALM SPRINGS CA
92262-7963
US

V. Phone/Fax

Practice location:
  • Phone: 760-778-5355
  • Fax: 760-778-5358
Mailing address:
  • Phone: 760-778-5355
  • Fax: 760-778-5358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberA45202
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberA45202
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberA45202
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License NumberA45202
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA45202
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberA45202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: