Healthcare Provider Details

I. General information

NPI: 1013370832
Provider Name (Legal Business Name): JEFFREY ST. JOHN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 PROVIDENCE PARK DR E
MOBILE AL
36695-4617
US

IV. Provider business mailing address

35 W LOURANDO DR
MOBILE AL
36606-2443
US

V. Phone/Fax

Practice location:
  • Phone: 251-650-2020
  • Fax: 251-650-1010
Mailing address:
  • Phone: 251-767-2380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number39380
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: