MEDICARE: DR. JOSEPH EDWARD ALLEN MD

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
1	207QS0010X	Sports Medicine (Family Medicine) Physician	A77476	CA
2	207Q00000X	Family Medicine Physician	A77476	CA

General Provider Information

NPI Number	:	1285720011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH EDWARD ALLEN MD

Provider Business Mailing Address
First Line	:	4116 W. POINT LOMA BLVD.
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5605
Country	:	US
Telephone Number	:	619-225-1212
Fax Number	:	619-225-1726

Provider Business Practice Location Address
First Line	:	4116 W. POINT LOMA BLVD.
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5605
Country	:	US
Telephone Number	:	619-225-1212
Fax Number	:	619-225-1726

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	11/19/2020

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