Provider Demographics
NPI:1073538302
Name:HALLAZGO, JEFFREY J (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:HALLAZGO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12680 OLIVE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6322
Mailing Address - Country:US
Mailing Address - Phone:314-251-8900
Mailing Address - Fax:314-251-8901
Practice Address - Street 1:714 GRAVOIS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7723
Practice Address - Country:US
Practice Address - Phone:636-326-6100
Practice Address - Fax:636-326-6110
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-05-10
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Provider Licenses
StateLicense IDTaxonomies
MOR4G27207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F21973Medicare UPIN