Healthcare Provider Details

I. General information

NPI: 1255394896
Provider Name (Legal Business Name): ALLEN OKIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6484 FORT CAROLINE RD
JACKSONVILLE FL
32277-2042
US

IV. Provider business mailing address

6520 FORT CAROLINE RD
JACKSONVILLE FL
32277-2044
US

V. Phone/Fax

Practice location:
  • Phone: 904-744-7300
  • Fax: 904-722-4271
Mailing address:
  • Phone: 904-745-3618
  • Fax: 904-722-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME45317
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME45317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: