Healthcare Provider Details

I. General information

NPI: 1558365171
Provider Name (Legal Business Name): DAVID P ALLEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 MAIN ST STE A
RAINELLE WV
25962-1253
US

IV. Provider business mailing address

PO BOX 457 200 POCAHONTAS TRAIL
WHITE SULPHUR SPRINGS WV
24986-0457
US

V. Phone/Fax

Practice location:
  • Phone: 304-438-8561
  • Fax: 304-438-6754
Mailing address:
  • Phone: 304-536-5030
  • Fax: 304-536-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number696
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102050099
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: