1134108830 NPI number — DR. JAMES THOMAS DOLL D.O.

Table of content: DR. JAMES THOMAS DOLL D.O. (NPI 1134108830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134108830 NPI number — DR. JAMES THOMAS DOLL D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOLL
Provider First Name:
JAMES
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134108830
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 JEFFERSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63119-3629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-991-4344
Provider Business Mailing Address Fax Number:
314-991-4345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
633 EMERSON RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CREVE COEUR
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141-6739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-991-4344
Provider Business Practice Location Address Fax Number:
314-991-4345
Provider Enumeration Date:
01/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  2000160486 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 179266 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 7348439 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 9949640001 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: H78278 . This is a "MERCY #80" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 48117 . This is a "EXCLUSIVE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 614098 . This is a "HEALTHLINK" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 168382 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2300376 . This is a "UNITHED HEALTH CARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".