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NPI Code Detail

MEDICARE: BRIAN H ALLEN DPM

MEDICARE: BRIAN H ALLEN DPM
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
1213E00000XPodiatrist0622AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386636678
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN H ALLEN DPM
Provider Business Mailing Address
First Line : PO BOX 9058
Second Line :
City : MESA
State : AZ
Zip : 85214-9058
Country : US
Telephone Number : 480-609-9300
Fax Number : 480-609-9350
Provider Business Practice Location Address
First Line : 2919 S ELLSWORTH RD
Second Line : SUITE 124
City : MESA
State : AZ
Zip : 85212-2167
Country : US
Telephone Number : 480-633-7944
Fax Number : 480-633-0255
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2005
Last Update Date : 01/03/2013

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