Individual
KEITH R. ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2115 S FREMONT AVE, STE 5000, SPRINGFIELD, MO 65804-2239
(417) 820-3960
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
2013025450
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134186901
—
MO
05
—
199362001
—
AR
01
—
431560263
TRICARE
MO
01
—
P01222589
RR MCR
MO
Enumeration date
04/27/2006
Last updated
11/08/2019
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