Individual
MR. JERRY M LIDDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
4901 FOREST PARK AVE, DIV SURG ACCS PODIATRY, STE 420, SAINT LOUIS, MO 63108-1495
(314) 747-4769
(888) 824-2176
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(314) 747-4769
(888) 824-2176
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
2005018735
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
307371203
—
MO
Enumeration date
09/26/2005
Last updated
04/17/2025
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