MEDICARE: ALLEN K LEA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	114292	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	114292	OTHER	MO	MO LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	113046	OTHER		BLUE CROSS/BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649214594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLEN K LEA MD

Provider Business Mailing Address
First Line	:	4854 S ELDON AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65810-3710
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4854 S ELDON AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65810-3710
Country	:	US
Telephone Number	:	417-889-2058
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	02/24/2022

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