Healthcare Provider Details

I. General information

NPI: 1275688798
Provider Name (Legal Business Name): JEFFREY I SCHULMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 S NEW BALLAS RD SUITE 130
SAINT LOUIS MO
63141-8703
US

IV. Provider business mailing address

755 S NEW BALLAS RD SUITE 130
SAINT LOUIS MO
63141-8703
US

V. Phone/Fax

Practice location:
  • Phone: 314-432-2428
  • Fax:
Mailing address:
  • Phone: 314-432-2428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberR6484
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: