Healthcare Provider Details

I. General information

NPI: 1629392469
Provider Name (Legal Business Name): J BRIAN ALLEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

976 MOUNTAIN CITY HWY
ELKO NV
89801-2728
US

IV. Provider business mailing address

3325 RESEARCH WAY
CARSON CITY NV
89706-7913
US

V. Phone/Fax

Practice location:
  • Phone: 775-777-7587
  • Fax: 775-738-9584
Mailing address:
  • Phone: 775-888-6610
  • Fax: 775-887-7046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1210
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: