Provider Demographics
NPI:1750543542
Name:ALLEN, ROBERT J JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:ALLEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2153 VALLEYGATE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3681
Mailing Address - Country:US
Mailing Address - Phone:910-321-7246
Mailing Address - Fax:910-321-7245
Practice Address - Street 1:2153 VALLEYGATE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3681
Practice Address - Country:US
Practice Address - Phone:910-321-7246
Practice Address - Fax:910-321-7245
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201201510208100000X
VA0116020630390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5921417Medicaid
NC5921417Medicaid