Healthcare Provider Details

I. General information

NPI: 1265635973
Provider Name (Legal Business Name): RICHARD ERNST ALLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 E SONTERRA BLVD SUITE 601
SAN ANTONIO TX
78258-4089
US

IV. Provider business mailing address

7915 DEADWOOD RDG
CONVERSE TX
78109-1621
US

V. Phone/Fax

Practice location:
  • Phone: 210-499-6500
  • Fax:
Mailing address:
  • Phone: 210-499-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: