MEDICARE: ANTHONY ALEXANDER ALLEN C. PED.

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	174400000X	Specialist	20011	AZ

General Provider Information

NPI Number	:	1528199239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY ALEXANDER ALLEN C. PED.

Provider Business Mailing Address
First Line	:	18783 S AVENIDA RIO VELOZ
Second Line	:
City	:	SAHUARITA
State	:	AZ
Zip	:	85629-8172
Country	:	US
Telephone Number	:	520-304-1774
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 W CONTINENTAL RD STE 416
Second Line	:
City	:	GREEN VALLEY
State	:	AZ
Zip	:	85622-3591
Country	:	US
Telephone Number	:	520-399-1365
Fax Number	:	520-696-3338

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	02/22/2019

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