Provider Demographics
NPI:1710946025
Name:ALLEN, RAY E (MD)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:E
Last Name:ALLEN
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:P.O. BOX 1215
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67905
Mailing Address - Country:US
Mailing Address - Phone:620-624-5691
Mailing Address - Fax:620-624-3656
Practice Address - Street 1:2 PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901
Practice Address - Country:US
Practice Address - Phone:620-624-5691
Practice Address - Fax:620-624-3656
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-13069207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS055971OtherBCBS OF KANSAS
OK100202070AMedicaid
KS100082900BMedicaid
OK100202070AMedicaid
KS100082900BMedicaid
KS110186733Medicare ID - Type UnspecifiedPALMETTO GBA RAILROAD