Individual
JACK ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
915 PEACH LN, BURLESON, TX 76028-7091
(817) 995-5403
(206) 350-1562
Mailing address
915 PEACH LN, BURLESON, TX 76028-7091
(817) 995-5403
(206) 350-1562
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
F7989
TX
207Q00000X
Family Medicine Physician
F7989
TX
Other
Enumeration date
01/12/2012
Last updated
01/12/2012
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