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General NPI Number Information
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NPI Number | 1881637601
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Entity Type | Individual
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Provider Name | GARY W. ALLEN III M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 104 RIVER WALK BLVD
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-4753
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Country | US
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Telephone | 864-963-7287
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Fax |
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Provider Business Mailing Address
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Address Line | 104 RIVER WALK BLVD.
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City | SIMPSONVILLE
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State | SC
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Zip | 29681
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Country | US
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Telephone | 864-963-7287
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 13914
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License Number State | SC
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