Healthcare Provider Details

I. General information

NPI: 1700995339
Provider Name (Legal Business Name): DAVID ALAN JANSSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROGRESS POINT PKWY STE 206
O FALLON MO
63368-2207
US

IV. Provider business mailing address

20 PROGRESS POINT PKWY STE 206
O FALLON MO
63368-2207
US

V. Phone/Fax

Practice location:
  • Phone: 636-344-2014
  • Fax: 314-747-1476
Mailing address:
  • Phone: 636-344-2014
  • Fax: 314-747-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number103905
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number208810309
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036176531
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: