Basic Information
| Provider Information | |||||||||
| NPI: | 1770932766 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 650859 DEPT 710 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752658508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097476240 | ||||||||
| FaxNumber: | 4097471023 | ||||||||
| Practice Location | |||||||||
| Address1: | 2401 FM 646 RD W | ||||||||
| Address2: | |||||||||
| City: | DICKINSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775393249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816141256 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2016 | ||||||||
| LastUpdateDate: | 04/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | BP10057228 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | S2213 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.