Provider Demographics
NPI:1154398410
Name:ALLEN, DAVID RANDEL (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RANDEL
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:608 NW 9TH ST
Mailing Address - Street 2:SUITE 6200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1068
Mailing Address - Country:US
Mailing Address - Phone:405-272-7677
Mailing Address - Fax:405-231-3783
Practice Address - Street 1:608 NW 9TH ST
Practice Address - Street 2:SUITE 6200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1068
Practice Address - Country:US
Practice Address - Phone:405-272-7677
Practice Address - Fax:405-231-3783
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK16180207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100135950AMedicaid
OKF32188Medicare UPIN