Farris Jackson JR., MD

NPI #1083618904 in St Louis, Missouri

Provider Information

NPI Number: 1083618904
Entity Type: Individual
Name: Farris Jackson JR., MD
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Credential: MD
Enumeration Date: Jun 9, 2005
Last Updated: Feb 10, 2017

Practice Location

Address: 11200 TESSON FERRY RD.
Address 2: STE 100
City: St Louis
State: Missouri
ZIP Code: 63123-6922
Phone: (314) 849-1500

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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