Healthcare Provider Details

I. General information

NPI: 1063669125
Provider Name (Legal Business Name): JERALYN A ALLEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38135 MARKET SQ
ZEPHYRHILLS FL
33542-7505
US

IV. Provider business mailing address

38135 MARKET SQ
ZEPHYRHILLS FL
33542-7505
US

V. Phone/Fax

Practice location:
  • Phone: 813-780-2155
  • Fax: 813-355-5017
Mailing address:
  • Phone: 813-780-2155
  • Fax: 813-355-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME120500
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number99048726A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME120500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: