Provider Demographics
NPI:1104042977
Name:ALLISON, ROBERT (HIS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ALLISON
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 MID RIVERS MALL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1575
Mailing Address - Country:US
Mailing Address - Phone:636-397-6966
Mailing Address - Fax:636-397-6836
Practice Address - Street 1:318 MID RIVERS MALL DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1575
Practice Address - Country:US
Practice Address - Phone:636-397-6966
Practice Address - Fax:636-397-6836
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001192237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO107577Medicare UPIN
MO431779680AAAMedicare UPIN