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General NPI Number Information
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NPI Number | 1104287697
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Entity Type | Organization
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Legal Business Name | RESTORE DME MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 03/11/2016
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Last Update Date | 03/11/2016
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Provider Practice Location Address
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Address Line | 6410 S KINGS RANCH RD STE 1
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City | GOLD CANYON
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State | AZ
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Zip | 85118-7352
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Country | US
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Telephone | 480-689-9205
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Fax | 480-288-2879
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Provider Business Mailing Address
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Address Line | 6410 S KINGS RANCH RD STE 1
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City | GOLD CANYON
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State | AZ
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Zip | 85118-7352
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Country | US
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Telephone | 480-689-9205
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Fax | 480-288-2879
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT CHRISTIAAN ALLEN
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Credential | M.D.
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Telephone | 480-689-9205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 30153
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License Number State | AZ
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