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Specialty details in registry · Jefferson City, MO

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At a glance

1431 Southwest Blvd Ste 2, Jefferson City, MO 65109-2468

NPPES record updated Apr 9, 2026. Public records can lag behind changes at a practice.

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  • Are you accepting new patients?
  • Do you accept my specific insurance plan?
  • Do you provide the service I need at this address?
  • Do I need a referral, and what is the earliest appointment?

Insurance participation and appointment availability are not established by these public records.

Practice location

1431 Southwest Blvd Ste 2
Jefferson City, MO 65109-2468

Additional reported practice locations

13545 Barrett Parkway Dr Ste 302
Ballwin, MO 630215896
Phone: 3143942200
Professional details: NPI, taxonomy & registry record
NPI1790813095
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Registry details

Primary taxonomy
Specialty details in registry
Taxonomy code
320900000X
Enumeration date
Mar 1, 2007
Record updated
Apr 9, 2026
More registry details
Provider type
Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

251E00000X

Specialty details in registry

261QH0100X

Specialty details in registry

320900000X · Primary

License reported: 686512111 MO

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

1431 Southwest Blvd Ste 2
Jefferson City, MO 65109-2468
Phone
(573) 632-0262
Mailing address
33 S STATE ST FL 5

CHICAGO, IL 606032804
Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

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