Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | K2637 | TX |
N | 2080P0204X | Pediatric Emergency Doctor | K2637 | TX |
Y | 2080P0208X | Pediatric Infectious Diseases | K2637 | TX |
NPI | 1114923984 |
---|---|
Provider Name | Dr. Coburn Huckins Allen |
First Address | Austin, TX 78723-3079 |
Second Address | Austin, TX 78723-3077 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2005 |
Last Update Date | 02/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
116264601 | (05) | TX |
G62494 | (02) | TX |