Provider Demographics
NPI:1932195831
Name:ALLEN, VICKI JO (MD)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:JO
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4001 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1525
Mailing Address - Country:US
Mailing Address - Phone:972-420-1470
Mailing Address - Fax:972-420-1465
Practice Address - Street 1:4001 LONG PRAIRIE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1565
Practice Address - Country:US
Practice Address - Phone:972-420-1470
Practice Address - Fax:972-420-1465
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ8437207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047212801Medicaid
TX047212801Medicaid
TX89020JMedicare ID - Type Unspecified