MEDICARE: MR. HENRY WILLIAM WEST ALLEN IV MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	E4228	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063478493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HENRY WILLIAM WEST ALLEN IV MD

Provider Business Mailing Address
First Line	:	623 N 9TH STREET
Second Line	:	PO BOX 497
City	:	AUGUSTA
State	:	AR
Zip	:	72006
Country	:	US
Telephone Number	:	870-347-3300
Fax Number	:	870-347-3492

Provider Business Practice Location Address
First Line	:	2816 FOX MEADOW LN
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72404-9346
Country	:	US
Telephone Number	:	870-336-1676
Fax Number	:	870-336-1679

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	11/08/2013

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