Provider Demographics
NPI:1043974116
Name:ALLEN, JAMAL
Entity type:Individual
Prefix:
First Name:JAMAL
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13106 LIBERTY SKY LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3846
Mailing Address - Country:US
Mailing Address - Phone:832-439-1419
Mailing Address - Fax:
Practice Address - Street 1:13106 LIBERTY SKY LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3846
Practice Address - Country:US
Practice Address - Phone:832-439-1419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date: