Provider Demographics
NPI:1558346510
Name:KREHER, JEFFREY BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRIAN
Last Name:KREHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9160 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1874
Mailing Address - Country:US
Mailing Address - Phone:314-801-8898
Mailing Address - Fax:314-997-6837
Practice Address - Street 1:9160 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1874
Practice Address - Country:US
Practice Address - Phone:314-801-8898
Practice Address - Fax:314-997-6837
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237696207RS0010X, 207R00000X, 208000000X, 2080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200453550Medicaid
MA110082460Medicaid
IN200453550Medicaid
MA110082460Medicaid
MA0008200Medicare PIN