Provider Demographics
NPI:1316957798
Name:KEVIN L ALLISON MD PA
Entity type:Organization
Organization Name:KEVIN L ALLISON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-793-7000
Mailing Address - Street 1:3812 24TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1814
Mailing Address - Country:US
Mailing Address - Phone:806-793-7000
Mailing Address - Fax:806-793-9048
Practice Address - Street 1:3812 24TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1814
Practice Address - Country:US
Practice Address - Phone:806-793-7000
Practice Address - Fax:806-793-9048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2010-06-02
Deactivation Date:2007-09-21
Deactivation Code:
Reactivation Date:2010-02-05
Provider Licenses
StateLicense IDTaxonomies
TXH7685207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX210639501Medicaid
TX0A6014Medicare PIN
TX210639501Medicaid