Provider Demographics
NPI:1710935465
Name:ALLEN, GARY R (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5501 GORDON SMITH DR STE 500
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-3209
Mailing Address - Country:US
Mailing Address - Phone:214-703-8100
Mailing Address - Fax:214-703-3269
Practice Address - Street 1:5501 GORDON SMITH DR STE 500
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-3209
Practice Address - Country:US
Practice Address - Phone:214-703-8100
Practice Address - Fax:214-703-3269
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE2434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102160203Medicaid
TX102160203Medicaid
TXC12739Medicare UPIN
TX8G7243Medicare ID - Type Unspecified