Provider Demographics
NPI:1538134879
Name:HAGHIGHAT-JOU, MEHRDAD (DO)
Entity Type:Individual
Prefix:DR
First Name:MEHRDAD
Middle Name:
Last Name:HAGHIGHAT-JOU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47850 E 216TH ST
Mailing Address - Street 2:
Mailing Address - City:BRAYMER
Mailing Address - State:MO
Mailing Address - Zip Code:64624-8181
Mailing Address - Country:US
Mailing Address - Phone:660-484-3287
Mailing Address - Fax:
Practice Address - Street 1:11123 S TOWNE SQ
Practice Address - Street 2:STE. E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7816
Practice Address - Country:US
Practice Address - Phone:314-487-4537
Practice Address - Fax:314-487-8971
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116523207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine