MEDICARE: E. CLARK ALLEN, M.D. PROFESSIONAL CORPORATION

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	2084P0800X	Psychiatry Physician	A48040	CA

General Provider Information

NPI Number	:	1316193493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E. CLARK ALLEN, M.D. PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	2424 CARMEL VALLEY RD
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-3802
Country	:	US
Telephone Number	:	858-792-7241
Fax Number	:	858-534-6922

Provider Business Practice Location Address
First Line	:	2424 CARMEL VALLEY RD
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-3802
Country	:	US
Telephone Number	:	858-792-7241
Fax Number	:	858-534-6922

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. EDWARD CLARK ALLEN
Credential	:	M.D.
Telephone Number	:	858-792-7241

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	08/08/2008

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