Individual
JONATHAN D ROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 FIRST CAPITOL DRIVE, ST CHARLES, MO 63301
(636) 947-5444
Mailing address
220 COMPASS POINT DR, SAINT CHARLES, MO 63301-4405
(636) 947-4480
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
036086602
IL
2085R0202X
Diagnostic Radiology Physician
Primary
R8F12
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036086602
—
IL
05
—
203143300
—
MO
01
—
300102466
RAILROAD MEDICARE
MO
01
—
300102481
RAILROAD MEDICARE
MO
Enumeration date
07/19/2006
Last updated
07/08/2007
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