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General NPI Number Information
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NPI Number | 1922167402
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Entity Type | Organization
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Legal Business Name | GREEN BAY ALLERGY ASTHMA & IMMUNOLOGY S.C. OCONTO
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 203 SMITH AVE STE 1
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City | OCONTO
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State | WI
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Zip | 54153-1060
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Country | US
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Telephone | 920-834-8833
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Fax |
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Provider Business Mailing Address
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Address Line | 203 SMITH AVE STE 1
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City | OCONTO
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State | WI
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Zip | 54153-1060
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Country | US
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Telephone | 920-834-8833
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES W ALLEN
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Credential | MD
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Telephone | 920-336-5620
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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