Provider Demographics
NPI:1205800117
Name:MEAD, ALAN WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:WILLIAM
Last Name:MEAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5151 HIGHWAY 54 STE F
Mailing Address - Street 2:PO BOX 840
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3285
Mailing Address - Country:US
Mailing Address - Phone:573-302-1661
Mailing Address - Fax:573-302-1719
Practice Address - Street 1:54 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3050
Practice Address - Country:US
Practice Address - Phone:573-302-1661
Practice Address - Fax:573-302-1719
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR7P54207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207739707Medicaid
MO207739723Medicaid
MO207739707Medicaid
MOF84434Medicare UPIN
MO207739723Medicaid