Individual
DR. JENNIFER LEE DEMERTZIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
232 S WOODS MILL RD, CHESTERFIELD, MO 63017-3406
(314) 434-1500
(314) 548-4748
Mailing address
13209 CORPORATE EXCHANGE DR, BRIDGETON, MO 63044-3721
(314) 705-1602
(770) 237-4985
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2008007442
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245326966
—
MO
01
—
2008007442
STATE LICENSE
MO
05
—
ENROLLED
—
IL
Enumeration date
10/04/2006
Last updated
10/18/2019
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