Provider Demographics
NPI:1528001674
Name:PIONTEK, JEROME GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:GREGORY
Last Name:PIONTEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 SAINT LUKES CENTER DR
Mailing Address - Street 2:STE 302
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3509
Mailing Address - Country:US
Mailing Address - Phone:314-523-2595
Mailing Address - Fax:314-590-5947
Practice Address - Street 1:121 SAINT LUKES CENTER DR
Practice Address - Street 2:STE 302
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3509
Practice Address - Country:US
Practice Address - Phone:314-523-2595
Practice Address - Fax:314-590-5947
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8A98207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOR8A98OtherMEDICAL LICENSE
MOR8A98OtherMEDICAL LICENSE
MO0517150001Medicare NSC
A10419Medicare UPIN
MOMA4487002Medicare PIN