Healthcare Provider Details

I. General information

NPI: 1114662061
Provider Name (Legal Business Name): JENNIFER TITUS PIRTLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER TITUS MD

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 FORUM BLVD STE 100
COLUMBIA MO
65203-5431
US

IV. Provider business mailing address

1710 TIMBER CREEK DR
COLUMBIA MO
65202-1946
US

V. Phone/Fax

Practice location:
  • Phone: 573-445-5366
  • Fax:
Mailing address:
  • Phone: 816-769-3850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2019001295
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: