Healthcare Provider Details

I. General information

NPI: 1619951027
Provider Name (Legal Business Name): JEFFREY A PARRES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6812 STATE ROUTE 162 STE 200
MARYVILLE IL
62062-8562
US

IV. Provider business mailing address

12855 N 40 DR SUITE 375
SAINT LOUIS MO
63141-8635
US

V. Phone/Fax

Practice location:
  • Phone: 618-288-0900
  • Fax:
Mailing address:
  • Phone: 314-567-6071
  • Fax: 314-567-7961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number100027
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036-083896
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: