Healthcare Provider Details

I. General information

NPI: 1073219267
Provider Name (Legal Business Name): THEODULE JEAN BAPTISTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 MADISON ST
JEFFERSON CITY MO
65101-5200
US

IV. Provider business mailing address

PO BOX 843966
KANSAS CITY MO
64184-3966
US

V. Phone/Fax

Practice location:
  • Phone: 573-632-5000
  • Fax:
Mailing address:
  • Phone: 573-884-3300
  • Fax: 573-884-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2026033521
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: