Healthcare Provider Details

I. General information

NPI: 1861464299
Provider Name (Legal Business Name): RICHARD LAMAR ALLEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 W AVENUE J STE 7
LANCASTER CA
93534-2819
US

IV. Provider business mailing address

1523 W AVENUE J STE 7
LANCASTER CA
93534-2819
US

V. Phone/Fax

Practice location:
  • Phone: 661-945-2221
  • Fax: 661-945-0831
Mailing address:
  • Phone: 661-816-8478
  • Fax: 661-945-0831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA93669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: