| Doctor Name: | DR. JARED VISSER |
| NPI Number: | 1174812358 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 07001116A |
| Business Practice Address: | 11709 Old Ballas Rd Suite 201 Creve Coeur, MO - 631417029 |
| Business Phone Number: | 3144321903 |
| Business Fax Number: | 3144325105 |
| Mailing Address: | 11709 Old Ballas Rd, Suite 201 CREVE COEUR |
| State: | MO |
| Postal Code: | 631417029 |
| Phone Number: | 3144321903 |
| Fax Number: | 3144325105 |
| NPI Enumeration Date: | 03/29/2011 |
| NPI Last Update Date: | 08/02/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 07001116A |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IN |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |