Provider Demographics
NPI:1114071636
Name:ALLEN, ANN ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:ELIZABETH
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DANIEL BURNHAM CT
Mailing Address - Street 2:SUITE 365C
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5455
Mailing Address - Country:US
Mailing Address - Phone:415-561-9923
Mailing Address - Fax:415-922-6344
Practice Address - Street 1:1 DANIEL BURNHAM CT
Practice Address - Street 2:SUITE 365C
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5455
Practice Address - Country:US
Practice Address - Phone:415-561-9923
Practice Address - Fax:415-922-6344
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64529173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG64529OtherMEDICAL LICENSE