Provider Demographics
NPI:1952545550
Name:ALLEN, JUSTIN RICHARD
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:RICHARD
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 19TH ST
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3308
Mailing Address - Country:US
Mailing Address - Phone:917-324-9942
Mailing Address - Fax:
Practice Address - Street 1:901 18TH ST E
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3648
Practice Address - Country:US
Practice Address - Phone:229-353-6185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60266029207P00000X
FLTPME761207P00000X
IL036155966207P00000X
HIMD-23927207P00000X
IDMD-2526207P00000X
AL47781207P00000X
CAC159741207P00000X
AZ63785207P00000X
ARE-17178207P00000X
COCDR.0003441207P00000X
CT70770207P00000X
DECI-0026630207P00000X
DCMD500002611207P00000X
AK213862207Q00000X
GA70029207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine