Provider Demographics
NPI:1376663153
Name:ALLEN, DAVID R (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2211 CORINTH AVE
Mailing Address - Street 2:#204
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1650
Mailing Address - Country:US
Mailing Address - Phone:310-966-9194
Mailing Address - Fax:310-966-9196
Practice Address - Street 1:2211 CORINTH AVE
Practice Address - Street 2:#204
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1650
Practice Address - Country:US
Practice Address - Phone:310-966-9194
Practice Address - Fax:310-966-9196
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG25038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G25028Medicare ID - Type Unspecified
CAA42489Medicare UPIN