Healthcare Provider Details

I. General information

NPI: 1083982011
Provider Name (Legal Business Name): BRUCE H ALLEN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2752 ERIE AVE
CINCINNATI OH
45208-2207
US

IV. Provider business mailing address

2752 ERIE AVE
CINCINNATI OH
45208-2207
US

V. Phone/Fax

Practice location:
  • Phone: 513-871-0290
  • Fax: 513-871-6740
Mailing address:
  • Phone: 513-871-0290
  • Fax: 513-871-6740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number39480
License Number StateOH

VIII. Authorized Official

Name: DR. BRUCE HOWARD ALLEN
Title or Position: PRESIDENT
Credential: MD
Phone: 513-310-1104