Provider Demographics
NPI:1598118846
Name:PARKER, JONATHAN ROBERT BRESTOFF (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ROBERT BRESTOFF
Last Name:PARKER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:JONATHAN
Other - Middle Name:ROBERT
Other - Last Name:BRESTOFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:BOX 8118
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:660 S EUCLID AVE
Practice Address - Street 2:BOX 8118
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1010
Practice Address - Country:US
Practice Address - Phone:314-362-5943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016016967207ZC0006X, 207ZP0105X
MO2019029654207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine