Provider Demographics
NPI:1841375177
Name:ALLO, SIMON N (MD)
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:N
Last Name:ALLO
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 1:319 N BONNIE BRAE ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-3727
Mailing Address - Country:US
Mailing Address - Phone:940-591-6009
Mailing Address - Fax:940-591-9918
Practice Address - Street 1:319 N BONNIE BRAE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3727
Practice Address - Country:US
Practice Address - Phone:940-591-6009
Practice Address - Fax:940-591-9918
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4353207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
2293174OtherAETNA
3451394OtherCIGNA
TX109400501Medicaid
TX89410YOtherBCBS
TX109400501Medicaid
TX89410YOtherBCBS