Healthcare Provider Details

I. General information

NPI: 1821187667
Provider Name (Legal Business Name): HAROLD ALLEN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W UNDERWOOD ST
ORLANDO FL
32806-1111
US

IV. Provider business mailing address

4243 NW FEDERAL HWY
JENSEN BEACH FL
34957-3600
US

V. Phone/Fax

Practice location:
  • Phone: 800-735-1178
  • Fax: 772-223-6354
Mailing address:
  • Phone: 800-735-1178
  • Fax: 772-233-6354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101031712
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME105280
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME105280
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: