Provider Demographics
NPI:1841285970
Name:ALLEN, NEIL (MD)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:
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 1:2410 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-6004
Mailing Address - Country:US
Mailing Address - Phone:970-352-6353
Mailing Address - Fax:970-356-2264
Practice Address - Street 1:2410 W 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-6004
Practice Address - Country:US
Practice Address - Phone:970-352-6353
Practice Address - Fax:970-356-2264
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25171174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84059236904OtherPACIFICARE
COAL98938OtherBCBS
CO10380597OtherCAQH
CO01251719Medicaid
CO840592369003OtherROCKY MTN HEALTH
CO01251719Medicaid
COC98938Medicare PIN
CO160019699Medicare ID - Type UnspecifiedMEDICARE RAILROAD
COAL98938OtherBCBS
COCOA105092Medicare PIN