Basic Information
| Provider Information | |||||||||
| NPI: | 1386600864 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLECKENSTEIN | ||||||||
| FirstName: | JAQUELYN | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 S EUCLID AVE | ||||||||
| Address2: | CB 8124 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631101010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144747206 | ||||||||
| FaxNumber: | 3147472460 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 BARNES WEST DR | ||||||||
| Address2: | DIV IM GASTROENTEROLOGY, STE 200 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631416287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147472066 | ||||||||
| FaxNumber: | 3144545108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 11/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 2012005908 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 204999700 | 05 | MO | MEDICAID |