Provider Demographics
NPI:1689151805
Name:LISA E ALLEN DO PLLC
Entity Type:Organization
Organization Name:LISA E ALLEN DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-510-7000
Mailing Address - Street 1:P O BOX 132913
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713
Mailing Address - Country:US
Mailing Address - Phone:903-510-7000
Mailing Address - Fax:903-510-7005
Practice Address - Street 1:3131 TROUP HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8350
Practice Address - Country:US
Practice Address - Phone:903-510-7000
Practice Address - Fax:903-510-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM9794OtherTEXAS MEDICAL BOARD NUMBER FOR OWNER OF THE BUSINESS