Provider Demographics
NPI:1699727453
Name:ZAGOREN, ALLEN JEFFREY (DO)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:JEFFREY
Last Name:ZAGOREN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 PLEASANT ST STE 308
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1409
Mailing Address - Country:US
Mailing Address - Phone:515-241-4325
Mailing Address - Fax:515-241-6138
Practice Address - Street 1:1215 PLEASANT ST
Practice Address - Street 2:SUITE 308
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1416
Practice Address - Country:US
Practice Address - Phone:515-241-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-01906208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1699727453Medicaid
IA1699727453Medicaid
IAA89662Medicare UPIN
IAI22140019Medicare PIN