Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | J8196 | TX |
NPI | 1164415121 |
---|---|
Provider Name | Dr. Thomas Gordon Allen |
First Address | Norman, OK 73070-5718 |
Second Address | Mckinney, TX 75070-4828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2005 |
Last Update Date | 01/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
138562713 | (05) | TX |
G05169 | (02) |