Healthcare Provider Details

I. General information

NPI: 1043877301
Provider Name (Legal Business Name): SURBHI JAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 BELLEVUE AVE STE 400
SAINT LOUIS MO
63117-1858
US

IV. Provider business mailing address

200 HAWKINS DR DEPT OF
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-7455
  • Fax:
Mailing address:
  • Phone: 319-356-2294
  • Fax: 319-356-7533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2023010221
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number2023010221
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2023010221
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: