Basic Information
Provider Information
NPI: 1407353113
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALLEN
FirstName: REGAN
MiddleName: LEE
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7777 FOREST LN STE 570
Address2:  
City: DALLAS
State: TX
PostalCode: 752302571
CountryCode: US
TelephoneNumber: 9725664660
FaxNumber: 9725666413
Practice Location
Address1: 5323 HARRY HINES BLVD STOP 7200
Address2:  
City: DALLAS
State: TX
PostalCode: 753907200
CountryCode: US
TelephoneNumber: 2146483111
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/09/2018
LastUpdateDate: 11/10/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/10/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XT68-9TXY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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