Healthcare Provider Details

I. General information

NPI: 1811126170
Provider Name (Legal Business Name): DAVID PRESLEY ALLEN D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 KENTUCKY AVE STE B
BOGALUSA LA
70427-3913
US

IV. Provider business mailing address

537 KENTUCKY AVE STE B
BOGALUSA LA
70427-3913
US

V. Phone/Fax

Practice location:
  • Phone: 985-215-5618
  • Fax: 985-732-0100
Mailing address:
  • Phone: 985-215-5618
  • Fax: 985-732-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDPM.200052
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: