Provider Demographics
NPI:1073845574
Name:CHARLES W ALLEN MDPA
Entity Type:Organization
Organization Name:CHARLES W ALLEN MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-479-1363
Mailing Address - Street 1:2810 CENTER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-4987
Mailing Address - Country:US
Mailing Address - Phone:281-479-1363
Mailing Address - Fax:281-476-4113
Practice Address - Street 1:2810 CENTER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-4987
Practice Address - Country:US
Practice Address - Phone:281-479-1363
Practice Address - Fax:281-476-4113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2338261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC12736Medicare UPIN
TX00E745Medicare PIN