Healthcare Provider Details

I. General information

NPI: 1912268814
Provider Name (Legal Business Name): ALLEN A MEHR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD DEPT OF
TRIPLER AMC HI
96859-5001
US

IV. Provider business mailing address

1 JARRETT WHITE RD
TRIPLER AMC HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-2921
  • Fax: 808-433-1552
Mailing address:
  • Phone: 808-433-2921
  • Fax: 808-433-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number1076
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number02006742A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberDO-05007
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number05352
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: