Provider Demographics
NPI:1013957232
Name:ALLEN, DAVID MATTHEW (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MATTHEW
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1123 S PALESTINE ST
Mailing Address - Street 2:#200
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-3646
Mailing Address - Country:US
Mailing Address - Phone:903-675-1337
Mailing Address - Fax:903-675-4351
Practice Address - Street 1:1123 S PALESTINE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3646
Practice Address - Country:US
Practice Address - Phone:903-675-1337
Practice Address - Fax:903-675-4351
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1533213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7119262OtherAETNA PROVIDER NUMBER
TX1427226711OtherDME NPI
TX146346501Medicaid
TX0067GROtherBCBS PROVIDER NUMBER
TX8285178OtherBLUE LINK #
TXU85178Medicare UPIN
TX8285178OtherBLUE LINK #
TX5370860001Medicare NSC