Healthcare Provider Details

I. General information

NPI: 1679428965
Provider Name (Legal Business Name): JESSICA GORMLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S EUCLID AVENUE CB 8057
SAINT LOUIS MO
63110
US

IV. Provider business mailing address

660 S EUCLID AVENUE CB 8057
SAINT LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-7388
  • Fax: 833-301-0853
Mailing address:
  • Phone: 314-362-7388
  • Fax: 833-301-0853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number2026003961
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: