1972538569 NPI number — ROBERT J ALLEN M.D.

Table of content: ROBERT J ALLEN M.D. (NPI 1972538569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972538569 NPI number — ROBERT J ALLEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
ROBERT
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALLEN
Provider Other First Name:
ROBERT
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1972538569
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1425 S GREENFIELD RD
Provider Second Line Business Mailing Address:
101
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85206-5529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-981-3000
Provider Business Mailing Address Fax Number:
480-654-5761

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1425 S GREENFIELD RD
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85206-5529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-981-3000
Provider Business Practice Location Address Fax Number:
480-654-5761
Provider Enumeration Date:
07/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  15874 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)