Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 1457 | TX |
Y | 213ES0131X | Foot Surgery | 1457 | TX |
NPI | 1124175807 |
---|---|
Provider Name | Dr. Marque Anthony Allen |
First Address | San Antonio, TX 78240-1679 |
Second Address | San Antonio, TX 78240-1679 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 10/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10572631 | CAQH (01) | TX |
147689702 | (05) | TX |
8K7143 | BCBS (01) | TX |