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NPI Code Detail

MEDICARE: D GORDON ALLAN MD

MEDICARE: D GORDON ALLAN MD
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
1207X00000XOrthopaedic Surgery Physician036079986IL
2207XS0114XAdult Reconstructive Orthopaedic Surgery Physician036079986IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00692114OTHERILRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902892607
Entity Type Code : Individual
Provider Name (Legal Business Name) : D GORDON ALLAN MD
Provider Business Mailing Address
First Line : PO BOX 9469
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62791-9469
Country : US
Telephone Number : 217-547-9100
Fax Number : 217-547-9247
Provider Business Practice Location Address
First Line : 1301 S KOKE MILL RD
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62711-9252
Country : US
Telephone Number : 217-547-9100
Fax Number : 217-547-9247
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2005
Last Update Date : 03/13/2023

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Directions to “ D GORDON ALLAN MD” Practice Location

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