Provider Demographics
NPI:1417938929
Name:ROETHEMEYER, JANELLE (MD)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:ROETHEMEYER
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:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-842-4744
Mailing Address - Fax:314-842-3835
Practice Address - Street 1:13303 TESSON FERRY RD
Practice Address - Street 2:SUITE 150
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-4062
Practice Address - Country:US
Practice Address - Phone:314-842-4744
Practice Address - Fax:314-842-3835
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100838207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000000010034OtherESSENCE
MO4670232OtherAETNA
MO101014OtherBCBS
MO127489OtherGHP
MO271716OtherHEALTHLINK
MOG07379OtherMERCY
MO0400741OtherUHC
MO328352451Medicare PIN
MOG07379OtherMERCY
MO0400741OtherUHC
MO110190479Medicare PIN