Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2020020220 | MO |
N | 111NI0900X | Internist | 2020020220 | MO |
Y | 207RI0011X | Interventional Cardiology | 2020020220 | MO |
NPI | 1023384831 |
---|---|
Provider Name | Jeremy R Tietjens |
First Address | Saint Louis, MO 63131-2328 |
Second Address | Saint Louis, MO 63131-2328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2012 |
Last Update Date | 30/08/2021 |