1154760163 NPI number — DR. ALLISON CLAIRE FLAMMANG D.O.

Table of content: DR. ALLISON CLAIRE FLAMMANG D.O. (NPI 1154760163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154760163 NPI number — DR. ALLISON CLAIRE FLAMMANG D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLAMMANG
Provider First Name:
ALLISON
Provider Middle Name:
CLAIRE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154760163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2325 DOUGHERTY FERRY RD
Provider Second Line Business Mailing Address:
STE 104
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63122-3356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-835-4881
Provider Business Mailing Address Fax Number:
314-835-4886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11550 OLIVE BLVD STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CREVE COEUR
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141-7111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-525-2590
Provider Business Practice Location Address Fax Number:
314-590-5943
Provider Enumeration Date:
06/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  2016014433 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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