MEDICARE: DR. ALAN TOM M.D.

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	2086S0122X	Plastic and Reconstructive Surgery Physician	2024048097	MO

General Provider Information

NPI Number	:	1912356312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN TOM M.D.

Provider Business Mailing Address
First Line	:	1551 WALL ST STE 420
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3541
Country	:	US
Telephone Number	:	636-329-4036
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 WALL ST STE 420
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3541
Country	:	US
Telephone Number	:	636-329-4036
Fax Number	:

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

Provider Enumeration Date	:	06/07/2016
Last Update Date	:	07/20/2025

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