Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 88-109 | NM |
NPI | 1033203427 |
---|---|
Provider Name | Kevin J Allen |
First Address | Las Cruces, NM 88011-5049 |
Second Address | Las Cruces, NM 88011-5049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 14/04/2015 |