Basic Information
| Provider Information | |||||||||
| NPI: | 1104890995 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLMAN | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6907 | ||||||||
| Address2: | |||||||||
| City: | DOTHAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347935000 | ||||||||
| FaxNumber: | 3346158419 | ||||||||
| Practice Location | |||||||||
| Address1: | 4370 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DOTHAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347935000 | ||||||||
| FaxNumber: | 3346158419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 06/09/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | DO.447 | AL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 051515768 | 05 | AL | MEDICAID | 263894100 | 01 | FLORIDA MEDICAID | OTHER | 51527560 | 01 | AL | BCBS OF ALABAMA | OTHER | P00055566 | 01 | RAILROAD MEDICARE | OTHER | 1645702 | 01 | LA | MEDICAID | OTHER | 000833764E | 01 | GEORGIA MEDICAID | OTHER |