Provider Demographics
NPI:1083461024
Name:ALLAN, DOMINIC (DO)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:
Last Name:ALLAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:610 E MAIN ST # 1059
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84542-9998
Mailing Address - Country:US
Mailing Address - Phone:239-675-1996
Mailing Address - Fax:
Practice Address - Street 1:5100 PRAIRIE PKWY STE 205
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-8155
Practice Address - Country:US
Practice Address - Phone:319-222-2711
Practice Address - Fax:319-222-2714
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAR-13069207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine