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General NPI Number Information
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NPI Number | 1417213265
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Entity Type | Organization
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Legal Business Name | DEIDRA ALLEN LLC
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 04/10/2012
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Provider Practice Location Address
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Address Line | 9898 BISSONNET ST SUITE 410
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City | HOUSTON
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State | TX
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Zip | 77036-8270
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Country | US
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Telephone | 832-767-2357
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Fax | 832-623-7561
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Provider Business Mailing Address
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Address Line | 9898 BISSONNET ST SUITE 410
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City | HOUSTON
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State | TX
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Zip | 77036-8270
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Country | US
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Telephone | 832-767-2357
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Fax | 832-623-7561
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Authorized Official
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Title or Position | SELF
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Name | DEIDRA DESHUN ALLEN
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Credential | MD
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Telephone | 832-767-2357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | M1464
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License Number State | TX
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