NPI 1033513692

Jack Sailor

Practitioner Contractor Saint Louis, MO

Practice location

Address: 2206 Lucas Ave Unit 508, Saint Louis, MO 63103-1555
Phone: (314) 307-4197

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X Licence P059173009 (MO)

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Registry record

NPI: 1033513692
Entity type: Individual
Sex (as registered): Male
NPI issued: 10 Oct 2014
Record last updated: 10 Oct 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.