Healthcare Provider Details

I. General information

NPI: 1083839070
Provider Name (Legal Business Name): JESUS SALVADOR LIGOT JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BLACKHORSE HILL RD
COATESVILLE PA
19320-2040
US

IV. Provider business mailing address

318 JEFFERSON CIRCLE DR
FENTON MO
63026-4611
US

V. Phone/Fax

Practice location:
  • Phone: 610-384-7771
  • Fax:
Mailing address:
  • Phone: 636-825-2200
  • Fax: 636-825-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2018006625
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: