Provider Demographics
NPI:1871586610
Name:ALLEN, ROBERT K (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1575 SOQUEL DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1700
Mailing Address - Country:US
Mailing Address - Phone:831-479-3772
Mailing Address - Fax:831-479-3791
Practice Address - Street 1:1575 SOQUEL DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1700
Practice Address - Country:US
Practice Address - Phone:831-479-3772
Practice Address - Fax:831-479-3791
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG25241208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G252410Medicaid
AA1206247OtherDEA
CA00G252410Medicaid
AA1206247OtherDEA