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General NPI Number Information
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NPI Number | 1538150701
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Entity Type | Individual
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Provider Name | PHILLIP GLENN ALLEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 12/30/2020
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Provider Practice Location Address
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Address Line | 4950 ESSEN LN SUITE A
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City | BATON ROUGE
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State | LA
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Zip | 70809-3738
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Country | US
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Telephone | 225-765-1765
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Fax | 225-765-1768
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Provider Business Mailing Address
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Address Line | 4950 ESSEN LN SUITE A
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City | BATON ROUGE
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State | LA
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Zip | 70809-3738
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Country | US
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Telephone | 225-765-1765
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Fax | 225-765-1768
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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 | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 050863
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 050863
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 205859
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License Number State | LA
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