Healthcare Provider Details

I. General information

NPI: 1518030097
Provider Name (Legal Business Name): JILL M. BAER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD SUITE 257-C
SAINT LOUIS MO
63131-2322
US

IV. Provider business mailing address

605 MULBERRY GROVE CT
MANCHESTER MO
63021-7081
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-2112
  • Fax: 314-569-1270
Mailing address:
  • Phone: 636-527-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberR7564
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: