Provider Demographics
NPI:1265468409
Name:ALLEN, KIRK ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:ROBERT
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 CASS STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MONTERRY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4518
Mailing Address - Country:US
Mailing Address - Phone:831-373-2991
Mailing Address - Fax:831-373-6630
Practice Address - Street 1:1011 CASS STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:MONTERRY
Practice Address - State:CA
Practice Address - Zip Code:93940-4518
Practice Address - Country:US
Practice Address - Phone:831-373-2991
Practice Address - Fax:831-373-6630
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1923213E00000X
CAE19230213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E19230Medicaid
CA000E19230Medicaid