Provider Demographics
NPI:1497738785
Name:ALLEN, VICTORIA L (DO)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1651 IDLE ROCK FARM RD
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63011-1901
Mailing Address - Country:US
Mailing Address - Phone:314-518-2736
Mailing Address - Fax:
Practice Address - Street 1:2117 BENTLEY PLZ
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2124
Practice Address - Country:US
Practice Address - Phone:636-225-2273
Practice Address - Fax:636-225-2275
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2010-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR7P15204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO116943OtherBLUE CROSS BLUE SHIELD
MO431828874OtherGALAXY HEALTH NETWORK
MO431828874OtherMCS
MO5538116OtherAETNA
MOE96534OtherMERCY HEALTH PLANS
MO0105047OtherUNITED HEALTHCARE
MO431828874OtherCHOICECARE NETWORK
MO431828874OtherNPPN
MO205957OtherHEALTHLINK
MO431828874OtherPHCS
MO431828874OtherGREAT WEST
MO431828874OtherPHCS
MO431828874OtherGREAT WEST