Individual
MR. REZA JALAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 N ONE MILE RD, SUITE 1, DEXTER, MO 63841-1042
(573) 624-7788
Mailing address
PO BOX 368, DEXTER, MO 63841
(573) 624-3165
(573) 624-3157
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
112378
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111316
BCBS
MO
05
—
208949008
—
MO
01
—
341420
HEALTHLINK
MO
01
—
P00192519
RAILROAD MEDICARE
MO
Enumeration date
04/20/2006
Last updated
01/28/2013
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