Organization
JONATHAN ALLEY, D.O., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN E ALLEY D.O. (OWNER)
(260) 665-5170
Entity
Organization
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
207Q00000X
Family Medicine Physician
Primary
020014D6A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000263260
BLUE SHIELD
IN
05
—
100225890A
—
IN
01
—
4416561
AETNA
IN
01
—
5463
PHP
IN
Enumeration date
04/08/2010
Last updated
04/09/2024
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