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General NPI Number Information
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NPI Number | 1508480708
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Entity Type | Organization
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Legal Business Name | JACQUELYN B. GARRETT, M.D.
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Dates
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Enumeration Date | 06/03/2020
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Last Update Date | 06/03/2020
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Provider Practice Location Address
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Address Line | 11125 DUNN RD STE 411
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City | SAINT LOUIS
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State | MO
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Zip | 63136-6132
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Country | US
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Telephone | 314-355-7111
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Fax | 314-355-8604
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Provider Business Mailing Address
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Address Line | 11125 DUNN RD STE 411
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City | SAINT LOUIS
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State | MO
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Zip | 63136-6132
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Country | US
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Telephone | 314-355-7111
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Fax | 314-355-8604
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JACQUELYN BREWER GARRETT
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Credential | MD
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Telephone | 314-583-2263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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