Healthcare Provider Details

I. General information

NPI: 1083024848
Provider Name (Legal Business Name): JUSTIN ALLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 06/16/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 MEDICAL CENTER PARKWAY
CLINTON AR
72031-1529
US

IV. Provider business mailing address

PO BOX 1060
MARSHALL AR
72650-1060
US

V. Phone/Fax

Practice location:
  • Phone: 501-745-7888
  • Fax: 877-460-4576
Mailing address:
  • Phone: 501-362-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE9606
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: