Healthcare Provider Details

I. General information

NPI: 1811915275
Provider Name (Legal Business Name): JAMES KIRK ALLMAN PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 JEFFERSON ST NE STE 800
ALBUQUERQUE NM
87109-2132
US

IV. Provider business mailing address

8475 E HARTFORD DR STE 201
SCOTTSDALE AZ
85255-5477
US

V. Phone/Fax

Practice location:
  • Phone: 505-932-7112
  • Fax:
Mailing address:
  • Phone: 480-591-9345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number95PA23
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: