Provider Demographics
NPI:1073526489
Name:ALLEN, LAWRENCE E (MD)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:E
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 1:2181 ORANGE AVE E
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-6144
Mailing Address - Country:US
Mailing Address - Phone:850-513-7521
Mailing Address - Fax:
Practice Address - Street 1:960 LEARNING WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32306-4178
Practice Address - Country:US
Practice Address - Phone:850-644-1802
Practice Address - Fax:850-644-4251
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203270913Medicaid
14994OtherBLUE
F20826Medicare UPIN
14994OtherBLUE
P00383171Medicare PIN
001013289Medicare PIN
MO203270913Medicaid