Provider Demographics
NPI:1134231897
Name:ALLEN, ROBERT M (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12431 BRANTLEY COMMONS CT STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5681
Mailing Address - Country:US
Mailing Address - Phone:239-275-6001
Mailing Address - Fax:239-275-6160
Practice Address - Street 1:12431 BRANTLEY COMMONS CT STE 101
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5681
Practice Address - Country:US
Practice Address - Phone:239-275-6001
Practice Address - Fax:239-275-6160
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS71542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBA3954612OtherDEA
FL57353ZMedicare ID - Type Unspecified
FL250071000Medicaid
FLF94013Medicare UPIN