=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912223892
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLEN DIAGNOSTIC ASSOCIATES, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2010
-----------------------------------------------------
Last Update Date | 04/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 997 RAINTREE CIR SUITE 130
-----------------------------------------------------
City | ALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75013-4949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-390-7667
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 997 RAINTREE CIR SUITE 130
-----------------------------------------------------
City | ALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75013-4949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-390-7667
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROBERT M BARNETT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 972-390-7667
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | H4152
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------