Healthcare Provider Details

I. General information

NPI: 1356614176
Provider Name (Legal Business Name): ALLEN FAMILY MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7233 E BASELINE RD STE 126
MESA AZ
85209-5007
US

IV. Provider business mailing address

7233 E BASELINE RD STE 126
MESA AZ
85209-5007
US

V. Phone/Fax

Practice location:
  • Phone: 480-699-2222
  • Fax: 480-699-3033
Mailing address:
  • Phone: 480-699-2222
  • Fax: 480-699-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number44915
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36540
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number44915
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5521
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF07141310
License Number StateAZ

VIII. Authorized Official

Name: DR. GREGORY S ALLEN
Title or Position: PRESIDENT
Credential:
Phone: 480-699-2222