Healthcare Provider Details

I. General information

NPI: 1154688778
Provider Name (Legal Business Name): CHARLA BETH ALLEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 MARSHA SHARP FWY
LUBBOCK TX
79407-2520
US

IV. Provider business mailing address

3601 4TH ST 8143
LUBBOCK TX
79430-8143
US

V. Phone/Fax

Practice location:
  • Phone: 806-744-7223
  • Fax: 806-740-3325
Mailing address:
  • Phone: 806-743-2757
  • Fax: 806-743-1180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP8635
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number566027
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: