Healthcare Provider Details

I. General information

NPI: 1184697013
Provider Name (Legal Business Name): JILL OBERLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 S WOODS MILL RD SUITE 330 EAST
CHESTERFIELD MO
63017-3417
US

IV. Provider business mailing address

232 S WOODS MILL RD SUITE 330 EAST
CHESTERFIELD MO
63017-3417
US

V. Phone/Fax

Practice location:
  • Phone: 314-205-6737
  • Fax: 314-576-2378
Mailing address:
  • Phone: 314-205-6737
  • Fax: 314-576-2378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberMO108400
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number108400
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number108400
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: