Healthcare Provider Details

I. General information

NPI: 1598800609
Provider Name (Legal Business Name): JEFFREY SEMEYN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 CITY ROUTE 66
ST. ROBERT MO
65584
US

IV. Provider business mailing address

PO BOX 505164
SAINT LOUIS MO
63150-5164
US

V. Phone/Fax

Practice location:
  • Phone: 573-336-5100
  • Fax: 573-336-3118
Mailing address:
  • Phone: 417-829-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2010028295
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: