Individual
JACOB T ARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12855 N 40 DR STE 375, SAINT LOUIS, MO 63141-8657
(314) 567-6071
Mailing address
12855 N 40 DR STE 375, SAINT LOUIS, MO 63141-8657
(314) 567-6071
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
2018009509
MO
208800000X
Urology Physician
Primary
36145240
IL
Other
Enumeration date
04/28/2012
Last updated
12/01/2021
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