Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 31015 | CA |
NPI | 1356425979 |
---|---|
Provider Name | Dr. Robert Gerard Allen |
First Address | Petaluma, CA 94954-8301 |
Second Address | Petaluma, CA 94954-8301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |