Organization
JACK L. CROUGHAN INC
Active
Organization
JACK L. CROUGHAN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK LESTER CROUGHAN MD (PRESIDENT)
(314) 725-4004
Entity
Organization
Contact information
Practice address
1034 S BRENTWOOD BLVD, SUITE 970, SAINT LOUIS, MO 63117-1223
(314) 725-4004
(314) 725-4004
Mailing address
1034 S BRENTWOOD BLVD, SUITE 970, SAINT LOUIS, MO 63117-1223
(314) 725-4004
(314) 725-4004
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
R5543
MO
2084P0800X
Psychiatry Physician
Primary
R5543
MO
Other
Enumeration date
03/18/2010
Last updated
03/18/2010
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