Provider Demographics
NPI:1073132783
Name:ALLEN, JOSHUA RYAN
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:RYAN
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 FRANKLIN RD STE 220
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1588
Mailing Address - Country:US
Mailing Address - Phone:601-296-3050
Mailing Address - Fax:601-296-3060
Practice Address - Street 1:39 FRANKLIN RD STE 220
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1588
Practice Address - Country:US
Practice Address - Phone:601-296-3050
Practice Address - Fax:601-296-3060
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS32004208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics