Jackson, Farris

Jackson, Farris is an sole proprietor health care provider with primary practice located at 11200 Tesson Ferry Rd. Ste 100, St Louis MO 63123-6922. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Jackson, Farris can be contacted via phone (314) 849-1500.

Contact Information

Primary practice address
11200 Tesson Ferry Rd. Ste 100 St Louis MO 63123-6922
Phone: (314) 849-1500
Fax: (314) 849-8789
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X R9F09 Missouri

Profile Details

NPI number 1083618904
LBN Legal business name Jackson, Farris
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 9th, 2005
Last updated Feb 10th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083618904 NPPES
Missouri Other 290013015 MEDICARE RAILROAD
Missouri MEDICAID 202531513 MEDICARE RAILROAD

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