Provider Demographics
NPI:1356348544
Name:ALLEN, BRUCE HOWARD (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:HOWARD
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4460 RED BANK RD STE 220
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-2173
Mailing Address - Country:US
Mailing Address - Phone:513-871-0290
Mailing Address - Fax:513-871-6740
Practice Address - Street 1:4460 RED BANK RD STE 220
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2173
Practice Address - Country:US
Practice Address - Phone:513-871-0290
Practice Address - Fax:513-871-6740
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH39480207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0384927Medicaid
OHA78867Medicare UPIN
OHAL0464861Medicare ID - Type Unspecified