Individual
A. JILL DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
801 HAZELWEST DR, HAZELWOOD, MO 63042-1754
(314) 919-2700
Mailing address
801 HAZELWEST DR, HAZELWOOD, MO 63042-1754
(314) 919-2700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2008007440
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02908107
—
NY
05
—
1831382431
—
MO
01
—
P01128467
RAILROAD MEDICARE
MO
Enumeration date
08/27/2007
Last updated
06/21/2016
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