1801824297 NPI number — DR. GLORI ALLEN M.D.

Table of content: DR. GLORI ALLEN M.D. (NPI 1801824297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801824297 NPI number — DR. GLORI ALLEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
GLORI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801824297
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4102 N 1130 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HELPER
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84526-2206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-650-0327
Provider Business Mailing Address Fax Number:
435-472-6176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 W MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERRON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84523-4526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-650-0327
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X , with the licence number:  188477-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 146D00000X , with the licence number: 92-188466-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11337 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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