Liddell, Jerry M

Liddell, Jerry M is an individual health care provider with primary practice located at 4901 Forest Park Ave Div Surg Accs Podiatry, Ste 420, Saint Louis MO 63108-1495. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as his primary health care specialty. Liddell, Jerry M can be contacted via phone (314) 747-4769.

Contact Information

Primary practice address
4901 Forest Park Ave Div Surg Accs Podiatry, Ste 420 Saint Louis MO 63108-1495
Phone: (314) 747-4769
Fax: (888) 824-2176
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 2005018735 Missouri

Profile Details

NPI number 1700872611
LBN Legal business name Liddell, Jerry M
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 26th, 2005
Last updated Apr 25th, 2024 - about last year

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 1700872611 NPPES
Missouri MEDICAID 307371203

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