Healthcare Provider Details

I. General information

NPI: 1720473655
Provider Name (Legal Business Name): ASHTON JEAN BROOKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL STE 5F
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

1926 ALCOA HWY STE 330
KNOXVILLE TN
37920-1547
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-8151
  • Fax: 314-454-5220
Mailing address:
  • Phone: 865-305-9218
  • Fax: 314-491-3902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number63549
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: