Provider Demographics
NPI:1255319174
Name:ALLEN, DAVID ROSS (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ROSS
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2001 W ORANGE GROVE RD
Mailing Address - Street 2:# 312
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1141
Mailing Address - Country:US
Mailing Address - Phone:520-544-2449
Mailing Address - Fax:520-544-2934
Practice Address - Street 1:2001 W ORANGE GROVE RD
Practice Address - Street 2:# 312
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1141
Practice Address - Country:US
Practice Address - Phone:520-544-2449
Practice Address - Fax:520-544-2934
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ9200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ002000393OtherCIGNA
AZ013152002Medicaid
AZAZ0340020OtherBLUE CROSS
AZ013152OtherCMDP
AZ013152OtherCMDP