Healthcare Provider Details

I. General information

NPI: 1851537294
Provider Name (Legal Business Name): ROBERT B ALLEN 6082
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 1/2 STANFORD DR SE
ALBUQUERQUE NM
87106-3538
US

IV. Provider business mailing address

118 1/2 STANFORD DR SE
ALBUQUERQUE NM
87106-3538
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-0591
  • Fax:
Mailing address:
  • Phone: 505-266-0591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number6082
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: