Provider Demographics
NPI:1659484889
Name:ALLEN, VIVIAN JOANN (MD)
Entity type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:JOANN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4130 SALISBURY ROAD
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8033
Mailing Address - Country:US
Mailing Address - Phone:904-296-2857
Mailing Address - Fax:904-296-1648
Practice Address - Street 1:4130 SALISBURY ROAD
Practice Address - Street 2:SUITE 2000
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8033
Practice Address - Country:US
Practice Address - Phone:904-296-2857
Practice Address - Fax:904-296-1648
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2017-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0043872207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0407461-00Medicaid
FL15970Medicare ID - Type Unspecified
FL0407461-00Medicaid