Provider Demographics
NPI:1184697013
Name:OBERLE, JILL (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:OBERLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:232 S WOODS MILL RD
Mailing Address - Street 2:SUITE 330 EAST
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3417
Mailing Address - Country:US
Mailing Address - Phone:314-205-6737
Mailing Address - Fax:314-576-2378
Practice Address - Street 1:232 S WOODS MILL RD
Practice Address - Street 2:SUITE 330 EAST
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3417
Practice Address - Country:US
Practice Address - Phone:314-205-6737
Practice Address - Fax:314-576-2378
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOMO108400207QH0002X
MO108400207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205177116Medicaid
MO000095513Medicare PIN
MOH28858Medicare UPIN