Provider Demographics
NPI:1386707396
Name:MASLANKO, JERALD A (MD)
Entity type:Individual
Prefix:DR
First Name:JERALD
Middle Name:A
Last Name:MASLANKO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1391 SMIZER MILL RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7306
Mailing Address - Country:US
Mailing Address - Phone:636-343-3787
Mailing Address - Fax:636-349-6081
Practice Address - Street 1:1391 SMIZER MILL RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7306
Practice Address - Country:US
Practice Address - Phone:636-343-3787
Practice Address - Fax:636-349-6081
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR4A03207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA13901Medicare UPIN