Healthcare Provider Details

I. General information

NPI: 1194287359
Provider Name (Legal Business Name): JILL LONDON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL ALLEN

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MDG/SGGF 101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

60 MDG/SGGF 101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-7096
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2601
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2601
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: