Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | D3127 | TX |
Y | 208600000X | Surgeon | D3127 | TX |
NPI | 1003830217 |
---|---|
Provider Name | Ted W Allen |
First Address | Lubbock, TX 79410-1307 |
Second Address | Lubbock, TX 79410-1317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 06/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
130248107 | (05) | TX |
C12746 | (02) | TX |
D3127 | LICENSE (01) | TX |