Gregory Allen, PA-C
Individual provider Active NPI Surgical Physician Assistant · St Louis Park, MN
NPI 1972037059 · NPPES record last updated Apr 17, 2017
Key facts
- NPI
- 1972037059
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Physician Assistant 363AS0400X
- Practice address
- 5775 Wayzata Blvd Ste 140
St Louis Park, MN 55416-2660 - Phone
- (952) 738-4498
- NPI assigned
- Apr 17, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12401 | MN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medical Scanning Consultants PA | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | MN | Yes |
Addresses
Primary practice location
5775 Wayzata Blvd Ste 140
St Louis Park, MN 55416-2660
Mailing address
9676 Geisler Rd
Eden Prairie, MN 55347-3562
Phone (612) 703-5541
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All providers in St Louis Park, MN · Surgical Physician Assistant in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.