Provider Demographics
NPI:1629043740
Name:ALLEN, STAN D (DO)
Entity Type:Individual
Prefix:DR
First Name:STAN
Middle Name:D
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 E BEVERLY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3593
Mailing Address - Country:US
Mailing Address - Phone:928-681-8693
Mailing Address - Fax:928-681-8694
Practice Address - Street 1:1739 E BEVERLY AVE STE 102
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3593
Practice Address - Country:US
Practice Address - Phone:928-681-8693
Practice Address - Fax:928-681-8694
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3239207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ392548Medicaid
G49271Medicare UPIN
AZZWMBJH04Medicare PIN
AZ200028771Medicare PIN
AZ392548Medicaid