MEDICARE: DONALD W ALLISON PA

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	363A00000X	Physician Assistant	769	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	769	OTHER	NE	NE LICENSE

General Provider Information

NPI Number	:	1376500876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD W ALLISON PA

Provider Business Mailing Address
First Line	:	4920 SO. 30TH STREET
Second Line	:	SUITE 103
City	:	OMAHA
State	:	NE
Zip	:	68107-1656
Country	:	US
Telephone Number	:	402-734-4110
Fax Number	:	402-734-3990

Provider Business Practice Location Address
First Line	:	4920 SO. 30TH STREET
Second Line	:	SUITE 103
City	:	OMAHA
State	:	NE
Zip	:	68107-1656
Country	:	US
Telephone Number	:	402-734-4110
Fax Number	:	402-734-3990

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	06/07/2013

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Directions to “ DONALD W ALLISON PA” Practice Location

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