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Organization
JEFFERSON PHYSICIAN NETWORK, LLC
Active
Organization
JEFFERSON PHYSICIAN NETWORK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFF BUCK (INTERIEM CHIEF EXECUTIVE OFFICER)
(636) 933-1000
Entity
Organization
Contact information
Practice address
1105 W LIBERTY ST, FARMINGTON, MO 63640-1921
(636) 933-2900
(636) 933-8017
Mailing address
PO BOX 350, CRYSTAL CITY, MO 63019-0350
(636) 933-1299
(636) 933-8017
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
2009008025
MO
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
2010010722
MO
207RR0500X
Rheumatology Physician
2009017530
MO
Other
Enumeration date
02/01/2012
Last updated
02/01/2012
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