Healthcare Provider Details

I. General information

NPI: 1235199944
Provider Name (Legal Business Name): MARSHA M ALLEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 04/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 CANTWELL LN
CORPUS CHRISTI TX
78407-1705
US

IV. Provider business mailing address

13409 GEORGE RD
SAN ANTONIO TX
78230-3064
US

V. Phone/Fax

Practice location:
  • Phone: 361-289-3111
  • Fax: 866-370-0223
Mailing address:
  • Phone: 210-492-8922
  • Fax: 210-479-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL3225
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: