Healthcare Provider Details

I. General information

NPI: 1124339676
Provider Name (Legal Business Name): MARK ALLEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3591 S MERCY RD STE 204
GILBERT AZ
85297-2240
US

IV. Provider business mailing address

18444 N 25TH AVE STE 310
PHOENIX AZ
85023-1266
US

V. Phone/Fax

Practice location:
  • Phone: 866-974-2673
  • Fax: 866-939-2673
Mailing address:
  • Phone: 623-241-8716
  • Fax: 623-544-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number010716
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: