Provider Demographics
NPI:1295412351
Name:ALLEN, BRIAN MICHAEL (IDMT, 18D, ATP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:MICHAEL
Last Name:ALLEN
Suffix:
Gender:M
Credentials:IDMT, 18D, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 REILLY ST
Mailing Address - Street 2:
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7324
Mailing Address - Country:US
Mailing Address - Phone:760-443-9822
Mailing Address - Fax:
Practice Address - Street 1:BUILDING T3358 18TH SPECIAL FORCES WAY
Practice Address - Street 2:
Practice Address - City:HOFFMAN
Practice Address - State:NC
Practice Address - Zip Code:28347
Practice Address - Country:US
Practice Address - Phone:910-396-8115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians