Individual
DR. JONATHAN E ALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
424 WILLIAMS ST, ANGOLA, IN 46703-1556
(260) 665-5170
(260) 665-6979
Mailing address
424 WILLIAMS ST, ANGOLA, IN 46703-1556
(260) 665-5170
(260) 665-6979
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
20014061
IN
207Q00000X
Family Medicine Physician
Primary
50003955A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000263260
BS
IN
01
—
0004416561
AETNA
IN
01
—
5463
PHP
IN
Enumeration date
05/02/2006
Last updated
04/11/2013
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