# ALLAN R SUPAK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1649388497
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | 8521 | MT | — |
| 207Q00000X | Family Medicine Physician | 8521 | MT | Yes |

## Other

- **Enumeration date:** 08/29/2006
- **Last updated:** 12/09/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000018171 | BLUECROSSBLUESHIELD | MT |
| 05 | — | 0014110 | — | MT |