Provider Demographics
NPI:1063475523
Name:BIRMINGHAM, JEAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:E
Last Name:BIRMINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S BRENTWOOD BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1320
Mailing Address - Country:US
Mailing Address - Phone:314-918-8827
Mailing Address - Fax:314-918-9391
Practice Address - Street 1:1600 S BRENTWOOD BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-1320
Practice Address - Country:US
Practice Address - Phone:314-918-8827
Practice Address - Fax:314-918-9391
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1P89208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F6879Medicare UPIN