Healthcare Provider Details

I. General information

NPI: 1164471223
Provider Name (Legal Business Name): MARK DAVID ALLISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 CENTRAL AVE SUITE 106
RIVERSIDE CA
92506-2933
US

IV. Provider business mailing address

4100 CENTRAL AVE SUITE 106
RIVERSIDE CA
92506-2933
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-8332
  • Fax: 951-788-6380
Mailing address:
  • Phone: 951-788-8332
  • Fax: 951-788-6380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC50568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: