Provider Demographics
NPI:1215033774
Name:PROFESSIONALS IN OB-GYN, LLC
Entity Type:Organization
Organization Name:PROFESSIONALS IN OB-GYN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MORMOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-842-0340
Mailing Address - Street 1:3844 S LINDBERGH BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1368
Mailing Address - Country:US
Mailing Address - Phone:314-842-0340
Mailing Address - Fax:
Practice Address - Street 1:3844 S LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1368
Practice Address - Country:US
Practice Address - Phone:314-842-0340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty