Provider Demographics
NPI:1063467256
Name:ALLEN, GARY EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:EDWIN
Last Name:ALLEN
Suffix:
Gender:M
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:P.O. BOX 735863
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-5863
Mailing Address - Country:US
Mailing Address - Phone:281-888-8999
Mailing Address - Fax:281-305-4054
Practice Address - Street 1:9601 BAPTIST HEALTH DR STE 1100
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6333
Practice Address - Country:US
Practice Address - Phone:501-227-5240
Practice Address - Fax:501-227-9151
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC82262085R0204X
TXJ96112085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134365001Medicaid
AR5K724Medicare ID - Type Unspecified
AR134365001Medicaid