Provider Demographics
NPI:1437356771
Name:GLEESON, JOHN F JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:GLEESON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:12255 DEPAUL DR
Mailing Address - Street 2:SUITE 460
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044
Mailing Address - Country:US
Mailing Address - Phone:314-770-2300
Mailing Address - Fax:314-770-1843
Practice Address - Street 1:12255 DEPAUL DR
Practice Address - Street 2:SUITE 460
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044
Practice Address - Country:US
Practice Address - Phone:314-770-2300
Practice Address - Fax:314-770-1843
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2023-05-03
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Provider Licenses
StateLicense IDTaxonomies
MO2010003206208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200000486Medicaid