Individual
DR. JAI S PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1 JEFFERSON BARRACKS DR, SAINT LOUIS, MO 63125-4181
(314) 652-4100
Mailing address
310 LINCOLN ST, WATERLOO, IL 62298-1613
(618) 939-8161
Taxonomy
Speciality
Code
Description
License number
State
2081P0004X
Spinal Cord Injury Medicine Physician
Primary
35615
MO
Other
Enumeration date
04/18/2006
Last updated
05/15/2013
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