Provider Demographics
NPI:1992742928
Name:JONES, GRACE DIZON-RETIRO (DO)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:DIZON-RETIRO
Last Name:JONES
Suffix:
Gender:
Credentials:DO
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 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-966-5000
Mailing Address - Fax:314-747-3338
Practice Address - Street 1:3015 N BALLAS RD
Practice Address - Street 2:DEPT EMERGENCY MED
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2329
Practice Address - Country:US
Practice Address - Phone:314-966-5000
Practice Address - Fax:314-747-3338
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110873207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO245120514Medicaid
MO245120514Medicaid