Healthcare Provider Details

I. General information

NPI: 1720035058
Provider Name (Legal Business Name): LUIS GREGORIO ALLEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W COLONIAL DR STE 302
ORLANDO FL
32804-6863
US

IV. Provider business mailing address

425 W COLONIAL DR STE 302
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 407-601-1370
  • Fax:
Mailing address:
  • Phone: 407-601-1370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDR.0070374
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME72560
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME72560
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: