Provider Demographics
NPI:1528023397
Name:ALLEN, MARK L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5300 W PLANO PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4861
Mailing Address - Country:US
Mailing Address - Phone:972-612-8037
Mailing Address - Fax:972-867-6049
Practice Address - Street 1:5300 W PLANO PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4821
Practice Address - Country:US
Practice Address - Phone:972-612-8037
Practice Address - Fax:972-867-6049
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2022-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ1610208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046085901Medicaid
TX87M732Medicare ID - Type Unspecified
TX046085901Medicaid