Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 2616 | TX |
NPI | 1831211481 |
---|---|
Provider Name | Ted L. Allen |
First Address | Austin, TX 78731-2374 |
Second Address | Austin, TX 78731-2374 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |