Basic Information
| Provider Information | |||||||||
| NPI: | 1912998824 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLERGY PARTNERS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT. 453 PO BOX 1000 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381480001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285752625 | ||||||||
| FaxNumber: | 8283502174 | ||||||||
| Practice Location | |||||||||
| Address1: | 339 RACETRACK RD NW STE 17 | ||||||||
| Address2: | |||||||||
| City: | FT WALTON BCH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325471580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508631189 | ||||||||
| FaxNumber: | 8508631241 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 06/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8282771300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | K1844 | 01 | FL | MEDICARE PTAN | OTHER | 112667802 | 05 | FL | MEDICAID | 112667803 | 05 | FL | MEDICAID | 112667800 | 05 | FL | MEDICAID | 112667801 | 05 | FL | MEDICAID |