Provider Demographics
NPI:1538164785
Name:ALLEN, BIBB JR (MD)
Entity type:Individual
Prefix:
First Name:BIBB
Middle Name:
Last Name:ALLEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000A SOUTHBRIDGE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7718
Mailing Address - Country:US
Mailing Address - Phone:205-871-4274
Mailing Address - Fax:205-871-4301
Practice Address - Street 1:800 MONTCLAIR RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1908
Practice Address - Country:US
Practice Address - Phone:205-592-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000119162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009912296Medicaid
AL009911509Medicaid
AL051540923OtherBLUE CROSS
AL515-42681OtherBLUE CROSS
AL000082157Medicaid
AL511-60811OtherBLUE CROSS
AL515-40923OtherBLUE CROSS
AL4123296OtherAETNA
AL051082157OtherBLUE CROSS
AL009942851Medicaid
AL051505048OtherBLUE CROSS
AL171050Medicaid
C70559Medicare UPIN
AL171050Medicaid
AL511-60811OtherBLUE CROSS
AL009912296Medicaid