MEDICARE: DONALD WAIN ALLEN 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
1	207Q00000X	Family Medicine Physician	171351-1205	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	46-3815	OTHER	UT	MEDICARE RHC
2	46-3816	OTHER	UT	MEDICARE RHC

General Provider Information

NPI Number	:	1942224050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD WAIN ALLEN MD

Provider Business Mailing Address
First Line	:	PO BOX 730
Second Line	:
City	:	COALVILLE
State	:	UT
Zip	:	84017-0730
Country	:	US
Telephone Number	:	435-640-2524
Fax Number	:

Provider Business Practice Location Address
First Line	:	142 SOUTH 50 EAST
Second Line	:	POB 865
City	:	COALVILLE
State	:	UT
Zip	:	84017-0865
Country	:	US
Telephone Number	:	435-336-4403
Fax Number	:	435-336-5570

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	04/26/2017

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Directions to “ DONALD WAIN ALLEN MD” Practice Location

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