Provider Demographics
NPI:1952371163
Name:ALLEN, DAVID R (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:R
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 1:25350 C RD
Mailing Address - Street 2:
Mailing Address - City:SOLDIER
Mailing Address - State:KS
Mailing Address - Zip Code:66540-9306
Mailing Address - Country:US
Mailing Address - Phone:785-834-2643
Mailing Address - Fax:
Practice Address - Street 1:1603 W 4TH ST
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436-1153
Practice Address - Country:US
Practice Address - Phone:785-364-3205
Practice Address - Fax:785-364-3468
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0427617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100320420BMedicaid
KS058350Medicare PIN
KS100320420BMedicaid