Healthcare Provider Details

I. General information

NPI: 1972572535
Provider Name (Legal Business Name): TRAVIS R. ALLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 N LITCHFIELD RD STE A230
GOODYEAR AZ
85395-1252
US

IV. Provider business mailing address

5115 N DYSART RD STE 202-172
LITCHFIELD PARK AZ
85340-3032
US

V. Phone/Fax

Practice location:
  • Phone: 623-469-4688
  • Fax: 623-284-0959
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number62891
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number62891
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number62891
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: