Healthcare Provider Details

I. General information

NPI: 1649221953
Provider Name (Legal Business Name): JEFFREY RADFORD STOKES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/17/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL DIV PED ALLERGY/IMMUNO/PULMO
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-2694
  • Fax: 314-454-2515
Mailing address:
  • Phone: 314-454-2694
  • Fax: 314-454-2515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2016014808
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number2016014808
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number2016014808
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: