Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
FARRIS JACKSON JR., MD
Active Sole ProprietorSpecialist · ST LOUIS, MO
Registration Details
- NPI Number
- 1083618904
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jun 9, 2005 (20.866406055127 yrs)
- Last Updated
- Feb 10, 2017
- License
-
R9F09 (MO)
- Sole Proprietor
- Yes
Practice Information
- Address
-
11200 TESSON FERRY RD.STE 100ST LOUIS, MO, 631236922Browse MO providers · Browse ZIP 63123
- Phone
- 3148491500
- Fax
- 3148498789
- Primary Specialty
-
Specialist
174400000X
Other Specialist Providers in ST LOUIS, MO
| Name | Credential | NPI |
|---|---|---|
| KENNETH J BENNETT | MD | 1528257698 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.