Rowley-Herron, Jetuan L

Rowley-Herron, Jetuan L is an individual health care provider with primary practice located at 5471 Dr Martin Luther King Dr , Saint Louis MO 63112-4265. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Rowley-Herron, Jetuan L can be contacted via phone (314) 367-5820.

Contact Information

Primary practice address
5471 Dr Martin Luther King Dr Saint Louis MO 63112-4265
Phone: (314) 367-5820
Fax: (314) 367-7010
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036-111984 Illinois
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 036.111984 Illinois
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 2004020480 Missouri

Profile Details

NPI number 1003893785
LBN Legal business name Rowley-Herron, Jetuan L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 23rd, 2005
Last updated Dec 30th, 2013 - about 11 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 1003893785 NPPES
Illinois MEDICAID 036111984

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