Provider Demographics
NPI:1609878750
Name:AVEN, ALLAN BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:BARRY
Last Name:AVEN
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 1:5350 E ERICKSON DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2822
Mailing Address - Country:US
Mailing Address - Phone:520-733-2250
Mailing Address - Fax:520-733-2270
Practice Address - Street 1:5350 E ERICKSON DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2822
Practice Address - Country:US
Practice Address - Phone:520-733-2250
Practice Address - Fax:520-733-2270
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-042535207Q00000X
AZ40302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL465110Medicare ID - Type Unspecified
ILC41628Medicare UPIN