Provider Demographics
NPI:1740258391
Name:ALLEN, PATRICIA (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14271 TEMPLE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-5220
Mailing Address - Country:US
Mailing Address - Phone:877-561-2051
Mailing Address - Fax:877-561-2051
Practice Address - Street 1:7040 SEMINOLE PRATT WHITNEY RD
Practice Address - Street 2:SUITE 25 #124
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-5714
Practice Address - Country:US
Practice Address - Phone:877-561-2051
Practice Address - Fax:877-561-2051
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66057207P00000X
GA60151207P00000X
NY189779207P00000X
TXM7821207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26258OtherBCBS
FL376815500Medicaid
FL26258VMedicare ID - Type UnspecifiedMEDICARE
FLF91228Medicare UPIN