Individual
DR. RICHARD B. JENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 635-5264
(573) 556-1719
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 635-5264
(573) 556-1719
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R4C31
MO
207RG0100X
Gastroenterology Physician
Primary
R4C31
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110042201
MEDICARE RAILROAD
MO
05
—
202614905
—
MO
01
—
CP9089
RAILROAD GROUP
MO
Enumeration date
12/07/2005
Last updated
01/14/2014
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