Provider Demographics
NPI:1235301714
Name:ALLEN, MATTHEW W (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:W
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:MANAGED CARE DEPT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:963 BUTTE ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0828
Practice Address - Country:US
Practice Address - Phone:530-245-5900
Practice Address - Fax:530-245-5909
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME1026062085R0001X
CAA1119342085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000738600Medicaid
CA3285093OtherCIGNA
CAP00857460OtherRAILROAD MEDICARE
FL9973229OtherAETNA
FL3285093OtherCIGNA
CA1235301714OtherCALIFORNIA CHILDRENS SERVICES PROGRAM
FLP304208OtherFREEDOM HEALTH
FLP202295OtherFREEDOM OPTIMUN
FL000738600Medicaid
FLP304208OtherFREEDOM HEALTH
FLAZ864ZMedicare PIN