Provider Demographics
NPI:1427489988
Name:PRICE, JERAD (AS)
Entity type:Individual
Prefix:
First Name:JERAD
Middle Name:
Last Name:PRICE
Suffix:
Gender:M
Credentials:AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 ARLINGTON AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-4327
Mailing Address - Country:US
Mailing Address - Phone:314-712-5262
Mailing Address - Fax:
Practice Address - Street 1:1515 ARLINGTON AVE FL 1
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-4327
Practice Address - Country:US
Practice Address - Phone:314-712-5262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications