Provider Demographics
NPI:1043836844
Name:MCMANUS, JORDAN A (DO)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:A
Last Name:MCMANUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 SOUTH NEW BALLAS ROAD
Mailing Address - Street 2:SUITE 2009 B
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-251-6062
Mailing Address - Fax:314-251-4376
Practice Address - Street 1:621 SOUTH NEW BALLAS ROAD
Practice Address - Street 2:SUITE 2009 B
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-251-6062
Practice Address - Fax:314-251-4376
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020017232207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty