MEDICARE: ALLEN FOOT AND ANKLE MEDICINE AND SURGERY PLC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0204X	Vascular & Interventional Radiology Physician
2	225100000X	Physical Therapist
3	2085U0001X	Diagnostic Ultrasound Physician
4	2086S0129X	Vascular Surgery Physician
5	213E00000X	Podiatrist
6	213ER0200X	Radiology Podiatrist
7	213ES0103X	Foot & Ankle Surgery Podiatrist
8	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician
9	207Q00000X	Family Medicine Physician
10	207QS0010X	Sports Medicine (Family Medicine) Physician
11	207R00000X	Internal Medicine Physician
12	2085R0202X	Diagnostic Radiology Physician
13	207RS0010X	Sports Medicine (Internal Medicine) Physician
14	213EP1101X	Primary Podiatric Medicine Podiatrist	0622	AZ

NPI Number	:	1477678704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEN FOOT AND ANKLE MEDICINE AND SURGERY PLC

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	:	OWNER/PODIATRIST
Name	:	BRIAN HOLT ALLEN
Credential	:	DPM
Telephone Number	:	480-633-7944

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	02/20/2023