Healthcare Provider Details

I. General information

NPI: 1003132887
Provider Name (Legal Business Name): NATHAN D ALLISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 N WICKHAM RD SUITE 302
MELBOURNE FL
32940-2239
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-9230
  • Fax: 321-434-9231
Mailing address:
  • Phone: 321-434-9230
  • Fax: 321-951-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberME109885
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME109885
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: