Individual
MRS. JO JAEGER BONNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12680 OLIVE BLVD., STE. 200, ST. LOUIS, MO 63141
(314) 251-8892
(314) 251-8894
Mailing address
12680 OLIVE BLVD., STE. 200, ST. LOUIS, MO 63141
(314) 251-8892
(314) 251-8894
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
36705
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010567402
—
MO
Enumeration date
09/20/2006
Last updated
01/21/2010
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