Provider Demographics
NPI:1801868724
Name:ALLEN, SCOTT EUGENE (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:EUGENE
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N WALDROP DR
Mailing Address - Street 2:STE 802
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4705
Mailing Address - Country:US
Mailing Address - Phone:817-784-0156
Mailing Address - Fax:
Practice Address - Street 1:1001 N WALDROP DR
Practice Address - Street 2:STE 802
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4705
Practice Address - Country:US
Practice Address - Phone:817-275-3309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1339208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100284202Medicaid
TX88Y034Medicare ID - Type Unspecified
TX100284202Medicaid