Individual
MICHAEL DALE ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3704 NORTH BLVD, SUITE 1, ALEXANDRIA, LA 71301-3606
(318) 442-8399
(318) 448-9897
Mailing address
3704 NORTH BLVD, STE 1, PO BOX 6284, ALEXANDRIA, LA 71307-6284
(318) 442-8399
(318) 448-9897
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
11265R
LA
2085R0202X
Diagnostic Radiology Physician
Primary
11265R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1664243
—
LA
01
—
300082907
RAILROAD MEDICARE
LA
Enumeration date
07/11/2005
Last updated
05/09/2011
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