Healthcare Provider Details

I. General information

NPI: 1356875488
Provider Name (Legal Business Name): DANIEL DONALD ALLEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2017
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 PHYSICIANS DR
TALLAHASSEE FL
32308-4619
US

IV. Provider business mailing address

1616 PHYSICIANS DR
TALLAHASSEE FL
32308-4619
US

V. Phone/Fax

Practice location:
  • Phone: 850-431-5100
  • Fax: 850-431-7478
Mailing address:
  • Phone: 850-431-5100
  • Fax: 850-431-7478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS17395
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: