Healthcare Provider Details

I. General information

NPI: 1073132783
Provider Name (Legal Business Name): JOSHUA RYAN ALLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19059 CHAMPION FOREST DR STE 101
SPRING TX
77379-8597
US

IV. Provider business mailing address

455 SCHOOL ST STE 26
TOMBALL TX
77375-4595
US

V. Phone/Fax

Practice location:
  • Phone: 281-374-9700
  • Fax: 281-370-8765
Mailing address:
  • Phone: 281-374-9700
  • Fax: 281-370-8765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32004
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: