Provider Demographics
NPI:1598800609
Name:SEMEYN, JEFFREY (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:SEMEYN
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:PO BOX 505164
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5164
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:
Practice Address - Street 1:608 CITY ROUTE 66
Practice Address - Street 2:
Practice Address - City:ST. ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584
Practice Address - Country:US
Practice Address - Phone:573-336-5100
Practice Address - Fax:573-336-3118
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010028295207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1598800609Medicaid
MO1598800609Medicaid
MO132300152Medicare PIN