Healthcare Provider Details

I. General information

NPI: 1720294259
Provider Name (Legal Business Name): EVAN C ALLEN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N GREEN VALLEY PKWY STE 5C
HENDERSON NV
89074-5889
US

IV. Provider business mailing address

1701 N GREEN VALLEY PKWY STE 5C
HENDERSON NV
89074-5889
US

V. Phone/Fax

Practice location:
  • Phone: 702-541-8240
  • Fax: 702-541-8241
Mailing address:
  • Phone: 702-541-8240
  • Fax: 702-541-8241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EVAN C ALLEN
Title or Position: PRESIDENT
Credential: MD
Phone: 702-541-8240