Provider Demographics
NPI:1275590754
Name:ALLEN, SCOTT D (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2300 E 30TH ST
Mailing Address - Street 2:STE 105
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-8990
Mailing Address - Country:US
Mailing Address - Phone:505-327-0406
Mailing Address - Fax:505-326-4691
Practice Address - Street 1:2300 E 30TH ST
Practice Address - Street 2:STE 105
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-8990
Practice Address - Country:US
Practice Address - Phone:505-327-0406
Practice Address - Fax:505-326-4691
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM95-172207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM003476OtherBCBS #
NM180038671OtherRAILROAD MEDICARE
NM3441OtherLOVELACE
NMT9815Medicaid
NMPROVP11233OtherMOLINA SALUD
NM201000176OtherPRESBYTERIAN HEALTH PLAN
NM8504657687401A003WESOtherTRICARE #
NMNM003476OtherBCBS #