MEDICARE: ANTHONY S ALLEN PAC

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	363AM0700X	Medical Physician Assistant	PA386	NV

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

General Provider Information

NPI Number	:	1417937558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY S ALLEN PAC

Provider Business Mailing Address
First Line	:	755 N ROOP ST STE 112
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-3107
Country	:	US
Telephone Number	:	775-883-7938
Fax Number	:	775-883-0907

Provider Business Practice Location Address
First Line	:	755 N ROOP ST STE 112
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-3107
Country	:	US
Telephone Number	:	775-883-7938
Fax Number	:	775-883-0907

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	07/11/2023

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Directions to “ ANTHONY S ALLEN PAC” Practice Location

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