Healthcare Provider Details

I. General information

NPI: 1215960596
Provider Name (Legal Business Name): PETRA JAROSLAVA LIPSMEYER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

8300 DELMAR BLVD APT 403
SAINT LOUIS MO
63124-2187
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-2217
  • Fax:
Mailing address:
  • Phone: 501-690-4150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2006013149
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: