Provider Demographics
NPI:1962258566
Name:IVERSON, ALLEN JR
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:IVERSON
Suffix:JR
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 1:8611 CONCORD MILLS BLVD # 354
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-5400
Mailing Address - Country:US
Mailing Address - Phone:214-766-9013
Mailing Address - Fax:
Practice Address - Street 1:8611 CONCORD MILLS BLVD # 354
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-5400
Practice Address - Country:US
Practice Address - Phone:214-766-9013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy