MEDICARE: SARAH JANE TILLING DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	2011030408	MO

General Provider Information

NPI Number	:	1649433566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH JANE TILLING DO

Provider Business Mailing Address
First Line	:	1715 DEER TRACKS TRAIL ROAD
Second Line	:	STE 110
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131
Country	:	US
Telephone Number	:	314-919-2600
Fax Number	:	314-919-2677

Provider Business Practice Location Address
First Line	:	1715 DEER TRACKS TRL
Second Line	:	STE 110
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1839
Country	:	US
Telephone Number	:	314-919-2600
Fax Number	:	314-919-2677

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	08/02/2012

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