Provider Demographics
NPI:1316965783
Name:ALLEN, JONATHAN (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:ALLEN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4443 HAMPSHIRE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMPSHIRE
Mailing Address - State:TN
Mailing Address - Zip Code:38461-4558
Mailing Address - Country:US
Mailing Address - Phone:931-285-9356
Mailing Address - Fax:
Practice Address - Street 1:121 AUTUMN DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-6099
Practice Address - Country:US
Practice Address - Phone:985-872-5638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ73957207P00000X
NV27282207P00000X
LA023541207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine