Provider Demographics
NPI:1972629020
Name:ALLEN, JEAN M (DO)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2100 SOLAR DR.
Mailing Address - Street 2:STE 100
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0647
Mailing Address - Country:US
Mailing Address - Phone:805-988-9000
Mailing Address - Fax:805-988-9089
Practice Address - Street 1:2100 SOLAR DR.
Practice Address - Street 2:STE 100
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0647
Practice Address - Country:US
Practice Address - Phone:805-988-9000
Practice Address - Fax:805-988-9089
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS5170207Q00000X
CA20A12566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBJ437ZMedicare PIN
FLB59563Medicare UPIN