Provider Demographics
NPI:1164483301
Name:ALLEN, QUENTIN B (MD)
Entity Type:Individual
Prefix:DR
First Name:QUENTIN
Middle Name:B
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 1:1050 SE MONTEREY RD
Mailing Address - Street 2:#104
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994
Mailing Address - Country:US
Mailing Address - Phone:772-283-2020
Mailing Address - Fax:772-219-7924
Practice Address - Street 1:1050 SE MONTEREY RD STE 104
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4512
Practice Address - Country:US
Practice Address - Phone:772-283-2020
Practice Address - Fax:772-219-7924
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115918207W00000X
FLME0085754207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK33462Medicare ID - Type Unspecified
ILG91217Medicare UPIN
0425500001Medicare NSC
0425500001Medicare NSC