Individual
JACK GREGORY ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1100 VIRGINIA AVE, COLUMBIA, MO 65212-0001
(573) 884-7796
Mailing address
1612 TENNIS LN, SHEBOYGAN, WI 53083-3457
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
MO
Other
Enumeration date
03/31/2026
Last updated
03/31/2026
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