MEDICARE: RONALD LYNN ALLEN PH.D.

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	103TH0100X	Health Service Psychologist	P1392	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2005918	OTHER	TN	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	P1392	OTHER	TN	PSYCHOLOGIST LICENSE

General Provider Information

NPI Number	:	1184753311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD LYNN ALLEN PH.D.

Provider Business Mailing Address
First Line	:	9217 PARK WEST BLVD
Second Line	:	SUITE D-1
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4404
Country	:	US
Telephone Number	:	865-691-2425
Fax Number	:	865-531-8440

Provider Business Practice Location Address
First Line	:	9217 PARK WEST BLVD
Second Line	:	SUITE D-1
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4404
Country	:	US
Telephone Number	:	865-691-2425
Fax Number	:	865-531-8440

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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