Individual
DR. POONAM M JAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1 JEFFERSON BARRACKS DR BLDG 55, SAINT LOUIS, MO 63125-4181
(314) 308-6965
Mailing address
1 MEADOW ACRES, SAINT LOUIS, MO 63124-1460
(314) 308-6965
(314) 801-8700
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
102417
MO
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
102417
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206644031
—
MO
Enumeration date
01/24/2007
Last updated
05/06/2024
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