MEDICARE: JORDAN BALTER P.C.

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1851650824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORDAN BALTER P.C.

Provider Business Mailing Address
First Line	:	6220 S LINDBERGH BLVD
Second Line	:	STE 203
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-7839
Country	:	US
Telephone Number	:	314-422-3617
Fax Number	:

Provider Business Practice Location Address
First Line	:	6220 S LINDBERGH BLVD
Second Line	:	STE 203
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-7839
Country	:	US
Telephone Number	:	314-422-3617
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JORDAN BALTER
Credential	:	D.O.
Telephone Number	:	314-422-3617

Provider Enumeration Date	:	05/11/2012
Last Update Date	:	11/19/2013

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