Provider Demographics
NPI:1669660155
Name:ALLEN, MONTY EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:MONTY
Middle Name:EDWARD
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 1:1857 PINE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2429
Mailing Address - Country:US
Mailing Address - Phone:325-670-3073
Mailing Address - Fax:325-670-3129
Practice Address - Street 1:1857 PINE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2429
Practice Address - Country:US
Practice Address - Phone:325-670-3073
Practice Address - Fax:325-670-3129
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0030236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine