Provider Demographics
NPI:1033172499
Name:ALLEN, TIMOTHY DENVER (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DENVER
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11803 SOUTH FWY STE 203A
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7030
Mailing Address - Country:US
Mailing Address - Phone:817-759-9759
Mailing Address - Fax:
Practice Address - Street 1:11803 SOUTH FWY STE 203A
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7030
Practice Address - Country:US
Practice Address - Phone:817-759-9759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9009207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096407402Medicaid
TX096407406Medicaid
TX80810YOtherBC/BS
TX096407407Medicaid
TX8L11858Medicare PIN
TX00714JMedicare PIN
TX096407402Medicaid
TX8L11859Medicare PIN
TX80810YOtherBC/BS
TX8L11860Medicare PIN