Provider Demographics
NPI:1871594218
Name:SU, JENNIFER M (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:SU
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2712 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-1147
Mailing Address - Country:US
Mailing Address - Phone:573-893-5500
Mailing Address - Fax:573-893-3280
Practice Address - Street 1:2712 PLAZA DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-1147
Practice Address - Country:US
Practice Address - Phone:573-893-5500
Practice Address - Fax:573-893-3280
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2014-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO119368207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG99621Medicare UPIN