Healthcare Provider Details

I. General information

NPI: 1427484534
Provider Name (Legal Business Name): DUSTIN GREG ALLEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2013
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 ANTILLEY RD
ABILENE TX
79606-5209
US

IV. Provider business mailing address

2074 ANTILLEY RD
ABILENE TX
79606-5209
US

V. Phone/Fax

Practice location:
  • Phone: 325-698-3865
  • Fax: 257-931-2953
Mailing address:
  • Phone: 325-698-3865
  • Fax: 325-793-1295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA09357
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: