Provider Demographics
NPI:1376641886
Name:MCDONALD, JENNIFER K (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:16216 BAXTER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4770
Mailing Address - Country:US
Mailing Address - Phone:636-449-4700
Mailing Address - Fax:636-449-2595
Practice Address - Street 1:111 SAINT LUKES CENTER DR STE 44
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3509
Practice Address - Country:US
Practice Address - Phone:314-576-2424
Practice Address - Fax:314-576-2381
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOMO2002023850207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO310885359Medicare PIN