Healthcare Provider Details

I. General information

NPI: 1366540734
Provider Name (Legal Business Name): JASON LOES REINBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 PATIENTS FIRST DR STE 3600
WASHINGTON MO
63090-4700
US

IV. Provider business mailing address

901 PATIENTS FIRST DR STE 3600
WASHINGTON MO
63090-4700
US

V. Phone/Fax

Practice location:
  • Phone: 636-390-1595
  • Fax: 636-390-1596
Mailing address:
  • Phone: 636-390-1595
  • Fax: 636-390-1596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2007015092
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: