Provider Demographics
NPI:1871235077
Name:TRAVIS R. ALLEN, M.D., PLC
Entity Type:Organization
Organization Name:TRAVIS R. ALLEN, M.D., PLC
Other - Org Name:THE PILOT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-469-4688
Mailing Address - Street 1:5115 N DYSART RD STE 202-172
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-3032
Mailing Address - Country:US
Mailing Address - Phone:623-469-4688
Mailing Address - Fax:623-284-0959
Practice Address - Street 1:1616 N LITCHFIELD RD STE A230
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1252
Practice Address - Country:US
Practice Address - Phone:623-469-4688
Practice Address - Fax:623-284-0959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-08
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace MedicineGroup - Single Specialty