Provider Demographics
NPI:1972572535
Name:ALLEN, TRAVIS R (MD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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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:
Mailing Address - Fax:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ628912083A0100X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ117656Medicare PIN