Healthcare Provider Details

I. General information

NPI: 1538134879
Provider Name (Legal Business Name): MEHRDAD HAGHIGHAT-JOU D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11123 S TOWNE SQ STE. E
SAINT LOUIS MO
63123-7816
US

IV. Provider business mailing address

47850 E 216TH ST
BRAYMER MO
64624-8181
US

V. Phone/Fax

Practice location:
  • Phone: 314-487-4537
  • Fax: 314-487-8971
Mailing address:
  • Phone: 660-484-3287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number116523
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: