Healthcare Provider Details

I. General information

NPI: 1154461267
Provider Name (Legal Business Name): TONY ALLEMAN MD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 HERITAGE
BROUSSARD LA
70518-8046
US

IV. Provider business mailing address

105 MISSION HILLS DR
BROUSSARD LA
70518-6163
US

V. Phone/Fax

Practice location:
  • Phone: 337-451-4263
  • Fax: 337-451-4661
Mailing address:
  • Phone: 337-856-7636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number16803
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number016803
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number016803
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: