Healthcare Provider Details

I. General information

NPI: 1346655636
Provider Name (Legal Business Name): JARED EMERY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 MADISON ST
JEFFERSON CITY MO
65101-5227
US

IV. Provider business mailing address

1125 MADISON ST
JEFFERSON CITY MO
65101-5227
US

V. Phone/Fax

Practice location:
  • Phone: 573-632-5013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2014018317
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2014018317
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: