Provider Demographics
NPI:1962401117
Name:AGAPAY, ALLEN A (MD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:A
Last Name:AGAPAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1303
Mailing Address - Country:US
Mailing Address - Phone:602-258-9900
Mailing Address - Fax:602-258-9904
Practice Address - Street 1:20325 N 51ST AVE STE 124
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5665
Practice Address - Country:US
Practice Address - Phone:623-288-1615
Practice Address - Fax:602-774-3249
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24148208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ346983Medicaid
AZMD24148Medicare ID - Type UnspecifiedMEDICARE