Provider Demographics
NPI:1790751634
Name:SHER, ALLYN L (MD)
Entity Type:Individual
Prefix:
First Name:ALLYN
Middle Name:L
Last Name:SHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N. KEENE STREET
Mailing Address - Street 2:SUITE 301
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201
Mailing Address - Country:US
Mailing Address - Phone:573-449-2141
Mailing Address - Fax:573-875-2328
Practice Address - Street 1:525 N. KEENE STREET
Practice Address - Street 2:SUITE 301
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201
Practice Address - Country:US
Practice Address - Phone:573-449-2141
Practice Address - Fax:573-875-2328
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6F11174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA13952Medicare UPIN
MO003011215Medicare ID - Type Unspecified