Provider Demographics
NPI:1275626145
Name:ALLEN, STANTON HOLCOMB (MD)
Entity Type:Individual
Prefix:
First Name:STANTON
Middle Name:HOLCOMB
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 1:645 N ARLINGTON AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4505
Mailing Address - Country:US
Mailing Address - Phone:775-329-6241
Mailing Address - Fax:775-329-4921
Practice Address - Street 1:645 N ARLINGTON AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4505
Practice Address - Country:US
Practice Address - Phone:775-329-6241
Practice Address - Fax:775-329-4921
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5007207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV20-16328Medicaid
NV20-16328Medicaid
NVWQBBM04Medicare ID - Type Unspecified