MEDICARE: JEFFERY LYNN ALLYN M.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	207Q00000X	Family Medicine Physician	MD-48629	IA
2	207Q00000X	Family Medicine Physician	042.0015727	VT

General Provider Information

NPI Number	:	1386639516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY LYNN ALLYN M.D.

Provider Business Mailing Address
First Line	:	44 S MAIN ST
Second Line	:
City	:	RANDOLPH
State	:	VT
Zip	:	05060-1381
Country	:	US
Telephone Number	:	802-728-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 S MAIN ST
Second Line	:
City	:	RANDOLPH
State	:	VT
Zip	:	05060-1381
Country	:	US
Telephone Number	:	802-728-7000
Fax Number	:

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	03/01/2022

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