Doctor Name: | KEVIN J ALLEN |
NPI Number: | 1033203427 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 88-109 |
Business Practice Address: | 2465 S Telshor Blvd Las Cruces, NM - 880115049 |
Business Phone Number: | 5054409939 |
Business Fax Number: | |
Mailing Address: | 2465 S Telshor Blvd, LAS CRUCES |
State: | NM |
Postal Code: | 880115049 |
Phone Number: | 5054409939 |
Fax Number: | |
NPI Enumeration Date: | 10/03/2006 |
NPI Last Update Date: | 04/14/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 88-109 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |