Healthcare Provider Details

I. General information

NPI: 1972619633
Provider Name (Legal Business Name): ALEXANDRA GEORGES JENNINGS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD DEPARTMENT OF RADIOLOGY
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

14 COUNTRY AIRE DR
SAINT LOUIS MO
63131-2318
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6031
  • Fax: 314-251-6343
Mailing address:
  • Phone: 314-348-8287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2005022916
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: