Provider Demographics
NPI:1194793943
Name:THURMAN, JEROME E (MD,FACE)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:E
Last Name:THURMAN
Suffix:
Gender:M
Credentials:MD,FACE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 955534
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-5534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:636-669-2380
Practice Address - Street 1:711 VETERANS MEMORIAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-2106
Practice Address - Country:US
Practice Address - Phone:636-669-2219
Practice Address - Fax:636-669-2380
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101055207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208660019Medicaid
MO208660019Medicaid