Farris Jackson JR. MD

NPI 1083618904 - Specialist - 174400000X

NPI Details
NPI 1083618904
Gender Male
Enumeration Date 06/09/2005
Last Updated 08/01/2011
Entity Type Individual
Active Over 11 years ago
Practice Location
1011 BOWLES AVE
SUITE 300
FENTON MO, 63026-2395, US
Phone (636) 496-5030
Fax (636) 496-5025
Business Location
1011 BOWLES AVE
SUITE 300
FENTON MO, 63026-2395, US
Phone (636) 496-5030
Fax (636) 496-5025
Toxanomy
Taxonomy Code 174400000X
License State Missouri
License Number R9F09
Remove 1083618904 NPI Number
 

According to our database, Farris Jackson JR. MD NPI is 1083618904, taxonomy code is 174400000X and license number is R9F09, license state is located at Missouri. Farris Jackson JR. MD physically located at 1011 Bowles Ave, Fenton MO, 63026-2395. NPI Number Farris Jackson JR. MD has the Individual type.

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1083618904 NPI number is provided on an as is basis without warranty of any kind. 1083618904 is maintained by the National Plan & Provider Enumeration System. The contents of Farris Jackson JR. MD are for informational purposes only.