Healthcare Provider Details

I. General information

NPI: 1235310079
Provider Name (Legal Business Name): ROBERT B ALLISON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 BUFFALO RD
ERIE PA
16510-2178
US

IV. Provider business mailing address

4234 BUFFALO RD
ERIE PA
16510-2178
US

V. Phone/Fax

Practice location:
  • Phone: 814-899-0691
  • Fax: 814-899-6260
Mailing address:
  • Phone: 814-899-0691
  • Fax: 814-899-6260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberOS 003552L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: