Provider Demographics
NPI:1831101781
Name:ALLCORN, DONALD KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:KENT
Last Name:ALLCORN
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 1:302 N. HWY 65
Mailing Address - Street 2:PO BOX 338
Mailing Address - City:LINCOLN
Mailing Address - State:MO
Mailing Address - Zip Code:65338
Mailing Address - Country:US
Mailing Address - Phone:660-547-3915
Mailing Address - Fax:660-547-3019
Practice Address - Street 1:302 N. HWY 65
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:MO
Practice Address - Zip Code:65338
Practice Address - Country:US
Practice Address - Phone:660-547-3915
Practice Address - Fax:660-547-3019
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6D94207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOB225336Medicare ID - Type Unspecified
MOE83592Medicare UPIN