Jerry H Allen, MD
Individual provider Active NPI Pediatrics Physician · Washington, MO
NPI 1154327286 · NPPES record last updated Oct 14, 2011
Key facts
- NPI
- 1154327286
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- MD34565 (MO)
- Practice address
- 851 E 5TH St
Ste 300
Washington, MO 63090-3130 - Phone
- (636) 390-8555
- Fax
- (636) 390-9444
- NPI assigned
- Jun 23, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD34565 | MO | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ozarks Medical Center | Past | Accepting new patients |
Interoperability endpoints
- jallen76899@directc.mercy.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD34565 | MO | Yes |
Addresses
Primary practice location
851 E 5TH St
Ste 300
Washington, MO 63090-3130
Mailing address
851 E 5TH St
Ste 300
Washington, MO 63090-3130
Phone (636) 390-8555
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- Karen Altemueller
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All providers in Washington, MO · Pediatrics Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.