Provider Demographics
NPI:1255353983
Name:ALLEN, ROBERT JOHNSON SR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHNSON
Last Name:ALLEN
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:JOHNSON
Other - Last Name:ALLEN
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:MD, FACS
Mailing Address - Street 1:4429 CLARA ST STE 330
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6957
Mailing Address - Country:US
Mailing Address - Phone:888-890-3437
Mailing Address - Fax:843-727-3774
Practice Address - Street 1:57 W 57TH ST STE 1603
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2828
Practice Address - Country:US
Practice Address - Phone:888-890-3437
Practice Address - Fax:843-727-3774
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2024-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150082-1208200000X
SC12264208200000X
LA013956208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1330281Medicaid
LA1330281Medicaid