Provider Demographics
NPI:1649267675
Name:JORDAN-CHILDS, SABRINA DANISE (MD)
Entity type:Individual
Prefix:DR
First Name:SABRINA
Middle Name:DANISE
Last Name:JORDAN-CHILDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SABRINA
Other - Middle Name:DANISE
Other - Last Name:JORDAN-CHILDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6121 N HANLEY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63134-2003
Mailing Address - Country:US
Mailing Address - Phone:314-615-0400
Mailing Address - Fax:
Practice Address - Street 1:6121 N HANLEY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63134-2003
Practice Address - Country:US
Practice Address - Phone:314-615-6909
Practice Address - Fax:314-615-0599
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009018422207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209362604Medicaid
MO2009018422OtherMO LICENSEE
MO107530084OtherWPS MEDICARE