Organization
JEFFERSON CITY MEDICAL GROUP, P.C.
Active
Other names
Jefferson City Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY LEE PATRICK M.D. (PRESIDENT)
(573) 635-5264
Entity
Organization
Contact information
Practice address
1241 W STADIUM BLVD, SUITE 1407, JEFFERSON CITY, MO 65109-6023
(573) 635-5264
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CD6059
MEDICARE RAILROAD
MO
Enumeration date
12/27/2006
Last updated
12/26/2018
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