Individual
JEREMY EARLE LEIDENFROST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
222 S WOODS MILL RD, #550N, CHESTERFIELD, MO 63017-3625
(314) 434-3049
Mailing address
222 S WOODS MILL RD, #550N, CHESTERFIELD, MO 63017-3625
(314) 434-3049
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2007016635
MO
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
2012032509
MO
Other
Enumeration date
06/21/2007
Last updated
01/06/2016
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