Provider Demographics
NPI:1538344411
Name:DONALD WAIN ALLEN
Entity type:Organization
Organization Name:DONALD WAIN ALLEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:D.
Authorized Official - Middle Name:WAIN
Authorized Official - Last Name:ALLEN, MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-336-4403
Mailing Address - Street 1:142 SOUTH 50 EAST
Mailing Address - Street 2:POB 865
Mailing Address - City:COALVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84017-0865
Mailing Address - Country:US
Mailing Address - Phone:435-336-4403
Mailing Address - Fax:435-336-5570
Practice Address - Street 1:142 SOUTH 50 EAST
Practice Address - Street 2:
Practice Address - City:COALVILLE
Practice Address - State:UT
Practice Address - Zip Code:84017
Practice Address - Country:US
Practice Address - Phone:435-336-4403
Practice Address - Fax:435-336-5570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT463816261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT463816Medicare Oscar/Certification