Provider Demographics
NPI:1942253026
Name:ALLMON, BRENT MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:MICHAEL
Last Name:ALLMON
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 1:4185 TECHNOLOGY FOREST BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-2005
Mailing Address - Country:US
Mailing Address - Phone:936-447-9483
Mailing Address - Fax:936-447-9410
Practice Address - Street 1:4185 TECHNOLOGY FOREST BLVD STE 210
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-2005
Practice Address - Country:US
Practice Address - Phone:936-447-9483
Practice Address - Fax:936-447-9410
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170670701Medicaid
GAP00237342Medicare PIN
TX8C2420Medicare PIN
TX170670701Medicaid