Healthcare Provider Details

I. General information

NPI: 1760479141
Provider Name (Legal Business Name): ALAN JENNINGS CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 W BUSINESS HWY 60
DEXTER MO
63841
US

IV. Provider business mailing address

PO BOX 39
DEXTER MO
63841-0039
US

V. Phone/Fax

Practice location:
  • Phone: 573-624-8051
  • Fax: 573-624-6669
Mailing address:
  • Phone: 573-624-8051
  • Fax: 573-624-6669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR1K96
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: