Individual
DR. JAMES TIMOTHY ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
122 S PETERSON AVE, LOUISVILLE, KY 40206-2537
(502) 931-1592
Mailing address
122 S PETERSON AVE, LOUISVILLE, KY 40206-2537
(502) 931-1592
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22964
KY
207QA0401X
Addiction Medicine (Family Medicine) Physician
22964
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26197001
MEDICARE PTAN
IN
Enumeration date
10/12/2006
Last updated
05/14/2019
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