Provider Demographics
NPI:1861995102
Name:DANIEL J ALLEN DO PC
Entity type:Organization
Organization Name:DANIEL J ALLEN DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-739-2661
Mailing Address - Street 1:PO BOX 1259
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83680-1259
Mailing Address - Country:US
Mailing Address - Phone:208-286-8670
Mailing Address - Fax:
Practice Address - Street 1:39 W PINE AVE STE B20
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2412
Practice Address - Country:US
Practice Address - Phone:208-286-8670
Practice Address - Fax:888-990-2969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty