Angel Allen Dermatology, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

114887 Issued in MO

Legal business name

ANGEL ALLEN DERMATOLOGY, LLC

Practice address

3234 W Truman Blvd
First Floor
Jefferson City, MO 65109-5708

Phone

(573) 659-1242

NPI assigned

May 19, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Angel L. Allen, M.D.

Title

Dermatologist

Phone

(573) 659-1242

Specialties & licenses 1

Addresses

Other names 1

• Angel Allen Dermatology Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1274227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348444800000",
    "number": "1851610653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 106142",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651106142",
            "telephone_number": "573-659-1242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3234 W TRUMAN BLVD",
            "address_2": "FIRST FLOOR",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651095708",
            "telephone_number": "573-659-1242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGEL ALLEN DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-19",
        "last_updated": "2012-09-24",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "ANGEL",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "DERMATOLOGIST",
        "authorized_official_telephone_number": "573-659-1242",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MO",
            "license": "114887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Angel Allen Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dermatology Physician in Jefferson City, MO
• Providers in Jefferson City, MO by specialty
• Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.