Healthcare Provider Details

I. General information

NPI: 1710263033
Provider Name (Legal Business Name): REBEKAH ALLEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 SAPPINGTON BRIDGE RD
SULLIVAN MO
63080-2354
US

IV. Provider business mailing address

660 MASON RIDGE CENTER DR STE 360
SAINT LOUIS MO
63141-8509
US

V. Phone/Fax

Practice location:
  • Phone: 573-468-4186
  • Fax: 573-860-6179
Mailing address:
  • Phone: 314-448-3791
  • Fax: 314-996-7658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2011031864
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2014036407
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: