Healthcare Provider Details

I. General information

NPI: 1245537778
Provider Name (Legal Business Name): CENTER FOR REPRODUCTIVE MEDICINE AND ROBOTIC SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 N NEW BALLAS RD SUITE 206
SAINT LOUIS MO
63141-6857
US

IV. Provider business mailing address

522 N NEW BALLAS RD SUITE 206
SAINT LOUIS MO
63141-6857
US

V. Phone/Fax

Practice location:
  • Phone: 314-473-1285
  • Fax:
Mailing address:
  • Phone: 314-473-1285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number2004003233
License Number StateMO

VIII. Authorized Official

Name: DR. SAJI JACOB
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 314-473-1285