Provider Demographics
NPI:1760542229
Name:DEVILLENEUVE, ALLAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:R
Last Name:DEVILLENEUVE
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 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:177-408-4508
Mailing Address - Fax:
Practice Address - Street 1:4001 WEST 15TH STREET, SUITE 375
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5862
Practice Address - Country:US
Practice Address - Phone:972-612-5346
Practice Address - Fax:972-599-1331
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5963208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics