Provider Demographics
NPI:1023197886
Name:ALLEN, DEBERENIA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBERENIA
Middle Name:ELIZABETH
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 E TROPICAL WAY
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-3343
Mailing Address - Country:US
Mailing Address - Phone:954-583-8066
Mailing Address - Fax:
Practice Address - Street 1:140A S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DANIA
Practice Address - State:FL
Practice Address - Zip Code:33004-3623
Practice Address - Country:US
Practice Address - Phone:954-922-7606
Practice Address - Fax:954-922-6898
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69884207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252351500Medicaid
FLME69884OtherLICENSE