Organization
JEFFERSON PEDIATRICS, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL GLINES M.D. (OWNER)
(636) 296-4466
Entity
Organization
Contact information
Practice address
1765 OLD STATE ROUTE 21, ARNOLD, MO 63010-3205
(636) 296-4466
Mailing address
1765 OLD STATE ROUTE 21, ARNOLD, MO 63010-3205
(636) 296-4466
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
34997
MO
Other
Enumeration date
08/20/2006
Last updated
08/22/2020
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