Provider Demographics
NPI:1306064423
Name:ALLEN, MATTHEW GORDON (MD)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:GORDON
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:301 SOUTH HIGHWAY 65
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051
Mailing Address - Country:US
Mailing Address - Phone:320-679-1313
Mailing Address - Fax:320-679-3507
Practice Address - Street 1:331 SOUTH HIGHWAY 65
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051
Practice Address - Country:US
Practice Address - Phone:320-679-1313
Practice Address - Fax:651-241-1116
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN50751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine