Provider Demographics
NPI:1891756557
Name:PAGE, JENNIFER LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:PAGE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:12639 OLD TESSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2786
Mailing Address - Country:US
Mailing Address - Phone:314-849-0311
Mailing Address - Fax:314-849-4423
Practice Address - Street 1:10010 KENNERLY RD
Practice Address - Street 2:4TH FLOOR - ACUTE REHAB
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2106
Practice Address - Country:US
Practice Address - Phone:314-525-4522
Practice Address - Fax:314-525-4598
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2019-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO1098632081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO122950092Medicare PIN
MOG29055Medicare UPIN