Healthcare Provider Details

I. General information

NPI: 1700232915
Provider Name (Legal Business Name): JACOB BUTTON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 CLAYTON RD STE 412
RICHMOND HEIGHTS MO
63117-1850
US

IV. Provider business mailing address

5700 HIGHLANDS PLAZA DR APT 4057
SAINT LOUIS MO
63110-1376
US

V. Phone/Fax

Practice location:
  • Phone: 314-381-1800
  • Fax: 314-442-7749
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2019033376
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: