Individual
JOHNATHAN SCHNEE FAGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
621 S NEW BALLAS RD STE 228A, SAINT LOUIS, MO 63141-8256
(314) 251-4968
(217) 545-4734
Mailing address
PO BOX 19627, SPRINGFIELD, IL 62794-9627
(217) 545-8000
(217) 545-4734
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
036153001
IL
207RP1001X
Pulmonary Disease Physician
Primary
2023032929
MO
Other
Enumeration date
06/14/2017
Last updated
10/05/2023
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