Provider Demographics
NPI:1518306679
Name:JUSTMANN, JESSICA JACLYN (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:JACLYN
Last Name:JUSTMANN
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-996-7200
Mailing Address - Fax:314-362-1185
Practice Address - Street 1:3015 N BALLAS RD
Practice Address - Street 2:DIV ANES PAIN MGT
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2329
Practice Address - Country:US
Practice Address - Phone:314-996-7200
Practice Address - Fax:314-362-1185
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2018003375208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200057650Medicaid