=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861488926
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEROME M ARONBERG MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2005
-----------------------------------------------------
Last Update Date | 11/23/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 141 N MERAMEC AVE SUITE 315
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63105-3750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-862-6221
-----------------------------------------------------
Fax | 314-863-9031
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 141 N MERAMEC AVE SUITE 315
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63105-3750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-862-6221
-----------------------------------------------------
Fax | 314-863-9031
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | R5056
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------