Provider Demographics
NPI:1972538569
Name:ALLEN, ROBERT J (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:J
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MC
Mailing Address - Street 1:1425 S GREENFIELD RD
Mailing Address - Street 2:101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-5529
Mailing Address - Country:US
Mailing Address - Phone:480-981-3000
Mailing Address - Fax:480-654-5761
Practice Address - Street 1:1425 S GREENFIELD RD
Practice Address - Street 2:101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5529
Practice Address - Country:US
Practice Address - Phone:480-981-3000
Practice Address - Fax:480-654-5761
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15874207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine