Provider Demographics
NPI:1104827351
Name:ALLEN, RICHARD C (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3705 MEDICAL PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1022
Mailing Address - Country:US
Mailing Address - Phone:512-458-2141
Mailing Address - Fax:512-458-4824
Practice Address - Street 1:3705 MEDICAL PKWY STE 120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1022
Practice Address - Country:US
Practice Address - Phone:512-458-2141
Practice Address - Fax:512-458-4824
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33235207W00000X
NM2002-0262207W00000X
TXK9978207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP00323169OtherMEDICARE ID
TX117117504 (MDACC)Medicaid
AZ708050Medicaid
NMNM001H54OtherBC BS OF NM
NM85104272Medicaid
NM342623502Medicare PIN
NMP00323169OtherMEDICARE ID
TX117117504 (MDACC)Medicaid
NM85104272Medicaid