Provider Demographics
NPI:1154382299
Name:ALLEN, HENRY M (DO)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1513
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1513
Mailing Address - Country:US
Mailing Address - Phone:405-321-5683
Mailing Address - Fax:405-329-0486
Practice Address - Street 1:2149 SW 59TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-7033
Practice Address - Country:US
Practice Address - Phone:405-682-0721
Practice Address - Fax:405-682-0757
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2596174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100129880AMedicaid
OK100742430AMedicaid
OK100129880AMedicaid
OK400522127Medicare ID - Type UnspecifiedMEDICARE GROUP