Provider Demographics
NPI:1760479141
Name:CHEN, ALAN JENNINGS (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JENNINGS
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-0039
Mailing Address - Country:US
Mailing Address - Phone:573-624-8051
Mailing Address - Fax:573-624-6669
Practice Address - Street 1:1516 W BUSINESS HWY 60
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841
Practice Address - Country:US
Practice Address - Phone:573-624-8051
Practice Address - Fax:573-624-6669
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1K96207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOR1K96OtherSTATE LICENCE
MO202742003Medicaid
MO4784OtherBC/BS
MO4784OtherBC/BS
MO108020002Medicare PIN