Individual
ALLEN K LEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4854 S ELDON AVE, SPRINGFIELD, MO 65810-3710
(417) 889-2058
Mailing address
4854 S ELDON AVE, SPRINGFIELD, MO 65810-3710
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
114292
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113046
BLUE CROSS/BLUE SHIELD
—
01
—
114292
MO LICENSE
MO
05
—
1649214594
—
MO
05
—
203834304
—
MO
Enumeration date
06/15/2006
Last updated
02/24/2022
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