Healthcare Provider Details

I. General information

NPI: 1558346510
Provider Name (Legal Business Name): JEFFREY BRIAN KREHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9160 CLAYTON RD
SAINT LOUIS MO
63124-1874
US

IV. Provider business mailing address

9160 CLAYTON RD
SAINT LOUIS MO
63124-1874
US

V. Phone/Fax

Practice location:
  • Phone: 314-801-8898
  • Fax: 314-997-6837
Mailing address:
  • Phone: 314-801-8898
  • Fax: 314-997-6837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number237696
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number237696
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number237696
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number237696
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: