Provider Demographics
NPI:1659369858
Name:ALLEN, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1705 E BROADWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-5852
Mailing Address - Country:US
Mailing Address - Phone:573-874-7800
Mailing Address - Fax:573-443-3627
Practice Address - Street 1:1432 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-2444
Practice Address - Country:US
Practice Address - Phone:573-632-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001633702085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2401112OtherUNITED HEALTHCARE
27488017OtherBCBS OF KC
40294OtherGHP
H20243OtherMERCY HEALTH PLANS
MO205073802Medicaid
130656OtherBCBS OF MO
5132415OtherAETNA
172361OtherHEALTHLINK
65201A003OtherTRICARE
MO920006099Medicare PIN
MO014012700Medicare PIN
5132415OtherAETNA
27488017OtherBCBS OF KC
2401112OtherUNITED HEALTHCARE
130656OtherBCBS OF MO
40294OtherGHP
MOMA1231006Medicare PIN