Healthcare Provider Details

I. General information

NPI: 1194144303
Provider Name (Legal Business Name): JESSICA HOUSTON ZWEIG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11133 DUNN RD STE 2335
SAINT LOUIS MO
63136-6165
US

IV. Provider business mailing address

11133 DUNN RD STE 2335
SAINT LOUIS MO
63136-6165
US

V. Phone/Fax

Practice location:
  • Phone: 314-653-5007
  • Fax:
Mailing address:
  • Phone: 314-653-5007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2016025629
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2016025629
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLL51237
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2016025629
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: