MEDICARE: DR. JEI FLORENSARI MARTIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	2013030328	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033104047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEI FLORENSARI MARTIN MD

Provider Business Mailing Address
First Line	:	3009 N BALLAS RD STE 383C
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2324
Country	:	US
Telephone Number	:	314-996-4545
Fax Number	:	314-273-0140

Provider Business Practice Location Address
First Line	:	3009 N BALLAS RD STE 383C
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-2324
Country	:	US
Telephone Number	:	314-996-4545
Fax Number	:	314-273-0140

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	02/08/2021

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