Healthcare Provider Details

I. General information

NPI: 1811918469
Provider Name (Legal Business Name): JODELL KAY ALLEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 NW 23RD AVE SUITE N
GAINESVILLE FL
32609-5415
US

IV. Provider business mailing address

4331 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4909
US

V. Phone/Fax

Practice location:
  • Phone: 352-378-9191
  • Fax: 352-372-4823
Mailing address:
  • Phone: 904-731-2755
  • Fax: 904-731-7376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number37420
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: