Provider Demographics
NPI:1548690597
Name:DEPLAZES, ALLEN P
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:P
Last Name:DEPLAZES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 SHELBURNE ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-5605
Mailing Address - Country:US
Mailing Address - Phone:701-852-0174
Mailing Address - Fax:701-858-8087
Practice Address - Street 1:300 3RD AVE SE STE A
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701
Practice Address - Country:US
Practice Address - Phone:701-852-0174
Practice Address - Fax:701-858-8087
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1548690597171M00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND15486905978Medicaid