Individual
JACOB STANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSA AA
Contact information
Practice address
11133 DUNN RD, SAINT LOUIS, MO 63136-6163
(800) 392-0936
Mailing address
3697 S NEW TOWN AVE APT 2, SAINT CHARLES, MO 63301-8136
(620) 899-1695
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
—
—
Other
Enumeration date
11/15/2023
Last updated
11/15/2023
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