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General NPI Number Information
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NPI Number | 1164459343
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Entity Type | Organization
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Legal Business Name | JASON C ALLEN DPM PLLC
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 04/27/2014
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Provider Practice Location Address
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Address Line | 1701 N STOCKTON HILL RD SUITE D
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City | KINGMAN
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State | AZ
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Zip | 86401-6600
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Country | US
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Telephone | 928-753-4500
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Fax | 928-753-2220
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Provider Business Mailing Address
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Address Line | 1701 N STOCKTON HILL RD SUITE D
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City | KINGMAN
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State | AZ
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Zip | 86401-6600
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Country | US
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Telephone | 928-753-4500
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Fax | 928-753-2220
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. JASON C ALLEN
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Credential | DPM
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Telephone | 928-753-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0641
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License Number State | AZ
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