Healthcare Provider Details

I. General information

NPI: 1811955974
Provider Name (Legal Business Name): LOREN BARRY ALLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 W POPLAR ST
ROGERS AR
72756-4245
US

IV. Provider business mailing address

614 E EMMA AVE SUITE 300
SPRINGDALE AR
72764-4634
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-9235
  • Fax: 479-631-0374
Mailing address:
  • Phone: 479-751-7417
  • Fax: 479-751-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberC4685
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: