Provider Demographics
NPI:1487672986
Name:ALLEN, DAVID MORE
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MORE
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3860 JACKSON AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1997
Mailing Address - Country:US
Mailing Address - Phone:801-627-0515
Mailing Address - Fax:801-627-0517
Practice Address - Street 1:3860 JACKSON AVE STE 2
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1979
Practice Address - Country:US
Practice Address - Phone:801-627-0515
Practice Address - Fax:801-627-0517
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT53160261205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTH87350Medicare UPIN
UT005731501Medicare UPIN