Provider Demographics
NPI:1942200183
Name:ALLEN, KAREN DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:DENISE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:715 TANK FARM RD
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7068
Mailing Address - Country:US
Mailing Address - Phone:805-543-4488
Mailing Address - Fax:805-543-6271
Practice Address - Street 1:715 TANK FARM RD
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7068
Practice Address - Country:US
Practice Address - Phone:805-543-4488
Practice Address - Fax:805-543-6271
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64792207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA070015255OtherRAILROAD MEDICARE
H51773Medicare UPIN
CA070015255OtherRAILROAD MEDICARE