Provider Demographics
NPI:1063544211
Name:ALLEN, JONATHAN SCOTT (HS)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:SCOTT
Last Name:ALLEN
Suffix:
Gender:M
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 AUCTION AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-1502
Mailing Address - Country:US
Mailing Address - Phone:901-521-4812
Mailing Address - Fax:901-544-3915
Practice Address - Street 1:2 AUCTION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-1502
Practice Address - Country:US
Practice Address - Phone:901-521-4812
Practice Address - Fax:901-544-3915
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman