Provider Demographics
NPI:1184687535
Name:ALLEN, DAVID EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EUGENE
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 1:690 GUZZI LANE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5292
Mailing Address - Country:US
Mailing Address - Phone:209-533-0333
Mailing Address - Fax:
Practice Address - Street 1:690 GUZZI LANE
Practice Address - Street 2:SUITE D
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5292
Practice Address - Country:US
Practice Address - Phone:209-533-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G483203Medicare PIN
CAA51006Medicare UPIN