Individual
JACOB OLIVER ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3506 FRONTIER DR, SAINT CHARLES, MO 63303-6636
(636) 544-2388
Mailing address
3506 FRONTIER DR, SAINT CHARLES, MO 63303-6636
(636) 544-2388
(636) 544-2388
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
390200000X
MO
Other
Enumeration date
10/11/2020
Last updated
10/11/2020
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