Provider Demographics
NPI:1992783948
Name:ALLEN, PATRICK JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOSEPH
Last Name:ALLEN
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 1:707 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3409
Mailing Address - Country:US
Mailing Address - Phone:307-527-7501
Mailing Address - Fax:
Practice Address - Street 1:424 YELLOWSTONE AVE STE 230
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414
Practice Address - Country:US
Practice Address - Phone:307-578-2975
Practice Address - Fax:307-578-2979
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-25758207Q00000X
OK3103207Q00000X
WY11254A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC047685OtherBLUE CROSS BLUE SHIELD
KS110105943OtherTRAVELERS MEDICARE
KS100235910AMedicaid
OK100045920BOtherOKLHAOMA MEDICAID
KS047685Medicare ID - Type Unspecified
OK100045920BOtherOKLHAOMA MEDICAID
KS100235910AMedicaid