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NPI Code Detail

MEDICARE: DR. JON GORDON ALLEN PH.D.

MEDICARE: DR. JON GORDON ALLEN PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist31822TX

General Provider Information

NPI Number : 1083814776
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JON GORDON ALLEN PH.D.
Provider Business Mailing Address
First Line : 2801 GESSNER DRIVE
Second Line :
City : HOUSTON
State : TX
Zip : 77080
Country : US
Telephone Number : 713-275-5507
Fax Number :
Provider Business Practice Location Address
First Line : 2801 GESSNER DR
Second Line :
City : HOUSTON
State : TX
Zip : 77080-2503
Country : US
Telephone Number : 713-275-5507
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2007
Last Update Date : 07/20/2007

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