Healthcare Provider Details

I. General information

NPI: 1295230068
Provider Name (Legal Business Name): ALLISON MARIE PAGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 ELM ST
MISSOURI VALLEY IA
51555-1140
US

IV. Provider business mailing address

1401 LONGVIEW LOOP
COUNCIL BLUFFS IA
51503-2440
US

V. Phone/Fax

Practice location:
  • Phone: 712-642-2794
  • Fax: 712-642-9338
Mailing address:
  • Phone: 661-437-9887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-48809
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: