Provider Demographics
NPI:1861627382
Name:HENRY ALLEN, MD, PA
Entity Type:Organization
Organization Name:HENRY ALLEN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-374-3857
Mailing Address - Street 1:275 W CAMBELL ROAD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080
Mailing Address - Country:US
Mailing Address - Phone:469-374-3857
Mailing Address - Fax:214-234-2762
Practice Address - Street 1:331 MELROSE DRIVE
Practice Address - Street 2:SUITE 220
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080
Practice Address - Country:US
Practice Address - Phone:469-828-1903
Practice Address - Fax:469-374-3851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0083QPOtherBLUECROSS BLUESHIELD
TX0A3999Medicare PIN