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NPI Code Detail

MEDICARE: MR. BRUCE R ALLEN M.S.W.

MEDICARE:  MR. BRUCE R ALLEN  M.S.W.
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
11041C0700XClinical Social WorkerC007AR

General Provider Information

NPI Number : 1568401602
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRUCE R ALLEN M.S.W.
Provider Business Mailing Address
First Line : 620 N OLIVE AVE
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72701-3527
Country : US
Telephone Number : 479-582-4422
Fax Number : 208-330-8228
Provider Business Practice Location Address
First Line : 111 E DAVIDSON ST
Second Line : P.O. BX. 3724
City : FAYETTEVILLE
State : AR
Zip : 72701-3413
Country : US
Telephone Number : 479-582-4422
Fax Number : 208-330-8228
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2006
Last Update Date : 07/08/2007

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Directions to “ MR. BRUCE R ALLEN M.S.W.” Practice Location

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