Individual
JACK PARKER PETRUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 PARK AVE, SAINT LOUIS, MO 63104-3024
(314) 833-2758
Mailing address
903 W SMITH ST, KIRKSVILLE, MO 63501-1674
(614) 558-0567
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/31/2025
Last updated
01/31/2025
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