Individual
DR. SAMUEL M. ALLEN II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
603 S ARCHUSA AVE, QUITMAN, MS 39355-2331
(601) 776-2123
(601) 776-6006
Mailing address
PO BOX 5208, MERIDIAN, MS 39302-5208
(601) 703-4282
(601) 703-4597
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
06374
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00014132
—
MS
01
—
010065827
RAILROAD MEDICARE
—
01
—
730-07862
BLUE CROSS OF AL
—
Enumeration date
11/20/2005
Last updated
11/06/2013
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