Individual
DR. SABRINA DANISE JORDAN-CHILDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6121 N HANLEY RD, SAINT LOUIS, MO 63134-2003
(314) 615-6909
(314) 615-0599
Mailing address
6121 N HANLEY RD, SAINT LOUIS, MO 63134-2003
(314) 615-0400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2009018422
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107530084
WPS MEDICARE
MO
01
—
2009018422
MO LICENSEE
MO
05
—
209362604
—
MO
Enumeration date
10/04/2005
Last updated
08/02/2019
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