Provider Demographics
NPI:1053901413
Name:ALLEN, ROBERT LASHAWN
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LASHAWN
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 1:1601 SW GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-7908
Mailing Address - Country:US
Mailing Address - Phone:580-291-8120
Mailing Address - Fax:
Practice Address - Street 1:1601 SW GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-7908
Practice Address - Country:US
Practice Address - Phone:580-291-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor