Individual provider · Type 1 NPI

Travis Wiley Jackson, MD

Dermatology Physician · St. Louis, MO

NPI number 1093657439 Active

Practice location

621 S New Ballas Rd Ste 3019B
St. Louis, MO 63141-8267

Call (314) 509-5305 Map

Fax (314) 251-4454

Specialties and licenses

TaxonomyCodeLicense
Dermatology Physician Primary 207N00000X2026021643 (MO)

Dermatology Physician: A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis an…

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About NPI 1093657439

Travis Wiley Jackson, MD's National Provider Identifier is 1093657439, issued on Apr 6, 2026. The primary taxonomy on file is Dermatology Physician (207N00000X), and the practice location is in St. Louis, MO. The record was last updated on May 27, 2026.