MEDICARE: STEPHEN C ALLEN 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	208800000X	Urology Physician	D44699	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00306112	OTHER	GA	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1437144904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN C ALLEN M.D.

Provider Business Mailing Address
First Line	:	425 W 3RD AVE
Second Line	:	SUITE 550
City	:	ALBANY
State	:	GA
Zip	:	31701-1941
Country	:	US
Telephone Number	:	229-432-8463
Fax Number	:	229-432-8465

Provider Business Practice Location Address
First Line	:	425 W 3RD AVE
Second Line	:	SUITE 550
City	:	ALBANY
State	:	GA
Zip	:	31701-1941
Country	:	US
Telephone Number	:	229-432-8463
Fax Number	:	229-432-8465

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	04/29/2008

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Directions to “ STEPHEN C ALLEN M.D.” Practice Location

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