Provider Demographics
NPI:1700583549
Name:ALLEN, TERRY DON JR
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:DON
Last Name:ALLEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10516 PRESTBURY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236
Mailing Address - Country:US
Mailing Address - Phone:317-250-4414
Mailing Address - Fax:
Practice Address - Street 1:10516 PRESTBURY DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236
Practice Address - Country:US
Practice Address - Phone:317-250-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver