Provider Demographics
NPI:1801093794
Name:ALLEN, LAURIE M (DO)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1170 N ESTRELLA PKWY STE A107
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9276
Mailing Address - Country:US
Mailing Address - Phone:623-263-0105
Mailing Address - Fax:623-292-8825
Practice Address - Street 1:1170 N ESTRELLA PKWY STE A107
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9276
Practice Address - Country:US
Practice Address - Phone:623-263-0105
Practice Address - Fax:623-292-8825
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5261207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ427928Medicaid
AZFA1370030OtherDEA
AZ131790Medicare PIN