Healthcare Provider Details

I. General information

NPI: 1649297151
Provider Name (Legal Business Name): JAMES WILLIAM ALLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 WEST LITTLE CANADA ROAD
LITTLE CANADA MN
55117
US

IV. Provider business mailing address

75 WEST LITTLE CANADA ROAD
LITTLE CANADA MN
55117
US

V. Phone/Fax

Practice location:
  • Phone: 651-481-1119
  • Fax: 651-481-1476
Mailing address:
  • Phone: 651-481-1119
  • Fax: 651-481-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20780
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: