Provider Demographics
NPI:1417213265
Name:DEIDRA ALLEN LLC
Entity Type:Organization
Organization Name:DEIDRA ALLEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SELF
Authorized Official - Prefix:
Authorized Official - First Name:DEIDRA
Authorized Official - Middle Name:DESHUN
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-767-2357
Mailing Address - Street 1:9898 BISSONNET ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8270
Mailing Address - Country:US
Mailing Address - Phone:832-767-2357
Mailing Address - Fax:832-623-7561
Practice Address - Street 1:9898 BISSONNET ST
Practice Address - Street 2:SUITE 410
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8270
Practice Address - Country:US
Practice Address - Phone:832-767-2357
Practice Address - Fax:832-623-7561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1464261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care