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General NPI Number Information
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NPI Number | 1164408514
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Entity Type | Individual
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Provider Name | ROGER K ALLEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/19/2005
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Last Update Date | 02/03/2014
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Provider Practice Location Address
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Address Line | 106 E MEMORIAL DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2502
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Country | US
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Telephone | 270-769-6327
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Fax | 270-769-1574
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Provider Business Mailing Address
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Address Line | 1451 W LINCOLN TRAIL BLVD NO. A CHRISTOPHER SQUARE
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City | RADCLIFF
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State | KY
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Zip | 40160-2548
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Country | US
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Telephone | 270-351-4954
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 20484
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License Number State | KY
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