MEDICARE: DR. PHILLIP GLENN 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	207K00000X	Allergy & Immunology Physician	050863	GA
2	207Y00000X	Otolaryngology Physician	050863	GA
3	207Y00000X	Otolaryngology Physician	205859	LA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538150701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP GLENN ALLEN M.D.

Provider Business Mailing Address
First Line	:	4950 ESSEN LN
Second Line	:	SUITE A
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3738
Country	:	US
Telephone Number	:	225-765-1765
Fax Number	:	225-765-1768

Provider Business Practice Location Address
First Line	:	4950 ESSEN LN
Second Line	:	SUITE A
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3738
Country	:	US
Telephone Number	:	225-765-1765
Fax Number	:	225-765-1768

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	12/30/2020

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Directions to “ DR. PHILLIP GLENN ALLEN M.D.” Practice Location

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