MEDICARE: TERRI LEE ALLEN M.D.

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	2085R0202X	Diagnostic Radiology Physician	GO256	TX

General Provider Information

NPI Number	:	1881642361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI LEE ALLEN M.D.

Provider Business Mailing Address
First Line	:	2406 GREEN PARK DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-3748
Country	:	US
Telephone Number	:	817-784-0156
Fax Number	:

Provider Business Practice Location Address
First Line	:	1199 8TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4102
Country	:	US
Telephone Number	:	817-335-9729
Fax Number	:

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/08/2007

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