Basic Information
| Provider Information | |||||||||
| NPI: | 1770599706 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3160 FOLSOM BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958165219 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3160 FOLSOM BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958165219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167335336 | ||||||||
| FaxNumber: | 9167335385 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A26723 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1288781 | 01 | CA | GREAT WEST | OTHER | 3042613 | 01 | CA | CIGNA | OTHER | 000810342855 | 01 | CA | PHCS | OTHER | 00A267230 | 01 | CA | BLUE SHIELD | OTHER | 500260 | 01 | CA | HEALTH NET | OTHER | 00A267230 | 05 | CA | MEDICAID | A26723 | 01 | CA | BLUE CROSS | OTHER | 90026131 | 01 | CA | PACIFICARE | OTHER | 1073199 | 01 | CA | FIRST HEALTH | OTHER | 4507060 | 01 | CA | AETNA | OTHER | 792441 | 01 | CA | UNITED HEALTHCARE | OTHER | MCMG123300 | 01 | CA | WESTERN HEALTH ADVANTAGE | OTHER | 1648 | 01 | CA | INTERPLAN | OTHER |