Provider Demographics
NPI:1750341137
Name:ALLEN, KENT R (MD)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2240
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85299-2240
Mailing Address - Country:US
Mailing Address - Phone:877-347-1557
Mailing Address - Fax:480-588-7976
Practice Address - Street 1:3411 E LARK DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-5652
Practice Address - Country:US
Practice Address - Phone:877-347-1557
Practice Address - Fax:480-588-7976
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ84464801Medicaid
AZAZ07245480OtherBCBS
AZP00110674OtherRR MEDICARE
AZZ77812Medicare PIN
AZ84464801Medicaid