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General NPI Number Information
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NPI Number | 1740702703
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Entity Type | Individual
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Provider Name | JONATHAN RAPHAEL SCHWEBER MB.BCH.BAO
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Gender | Male
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 07/01/2020
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Provider Practice Location Address
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Address Line | 1 CHILDREN'S PL CB 8116
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City | ST LOUIS
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State | MO
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Zip | 63110
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Country | US
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Telephone | 314-454-6095
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Fax | 314-454-2561
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Provider Business Mailing Address
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Address Line | 1617 S LINCOLN AVE
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City | SPRINGFIELD
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State | IL
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Zip | 62704-3418
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Country | US
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Telephone | 217-899-5004
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2020018961
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License Number State | MO
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