Provider Demographics
NPI:1295884021
Name:ALLEN, DAVID R (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17030 LAKESIDE HILLS PLAZA STE 102
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2396
Mailing Address - Country:US
Mailing Address - Phone:402-758-5800
Mailing Address - Fax:402-758-5809
Practice Address - Street 1:17030 LAKESIDE HILLS PLAZA STE 102
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2396
Practice Address - Country:US
Practice Address - Phone:402-758-5800
Practice Address - Fax:402-758-5809
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE359207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE278256Medicare PIN
NE098672Medicare Oscar/Certification