Healthcare Provider Details

I. General information

NPI: 1164483301
Provider Name (Legal Business Name): QUENTIN B ALLEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 08/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SE MONTEREY RD STE 104
STUART FL
34994-4512
US

IV. Provider business mailing address

1050 SE MONTEREY RD #104
STUART FL
34994
US

V. Phone/Fax

Practice location:
  • Phone: 772-283-2020
  • Fax: 772-219-7924
Mailing address:
  • Phone: 772-283-2020
  • Fax: 772-219-7924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036115918
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME0085754
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: