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General NPI Number Information
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NPI Number | 1215997069
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Entity Type | Individual
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Provider Name | JASON C ALLEN D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 3801 SANTA ROSA DR
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City | KINGMAN
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State | AZ
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Zip | 86401-2311
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Country | US
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Telephone | 928-263-4189
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Fax |
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Provider Business Mailing Address
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Address Line | 1249 RAWHIDE DR
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City | KINGMAN
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State | AZ
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Zip | 86401-7225
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Country | US
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Telephone | 928-515-1709
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0641
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License Number State | AZ
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Taxonomy #2
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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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