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Individual
MARK WAYNE ALLEN
Active
Individual
MARK WAYNE ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
19909
WV
207Q00000X
Family Medicine Physician
Primary
19909
WV
208000000X
Pediatrics Physician
19909
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1891779047
BLUE SHIELD
WV
05
—
3002489000
—
WV
Enumeration date
12/01/2005
Last updated
04/19/2010
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