Healthcare Provider Details

I. General information

NPI: 1528271434
Provider Name (Legal Business Name): CHRISTOPHER LEE ALLEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10012 KENNERLY RD SUITE 300
SAINT LOUIS MO
63128-2197
US

IV. Provider business mailing address

10012 KENNERLY RD SUITE 300
SAINT LOUIS MO
63128-2197
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-0602
  • Fax: 314-842-4372
Mailing address:
  • Phone: 314-842-0602
  • Fax: 314-842-4372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2013024996
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number2013024996
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: