1720041395 NPI number — JAMSHED GUL AGHA MD

Table of content: BRADLEY A DUKE PA-C (NPI 1477874725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720041395 NPI number — JAMSHED GUL AGHA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGHA
Provider First Name:
JAMSHED
Provider Middle Name:
GUL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1720041395
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 MEDICAL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WENTZVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-327-1202
Provider Business Mailing Address Fax Number:
636-327-1222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1475 KISKER RD
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
SAINT CHARLES
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63304-8781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-442-7300
Provider Business Practice Location Address Fax Number:
636-442-7319
Provider Enumeration Date:
04/06/2006

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: 207RH0003X , with the licence number:  2002016138 , 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: 1360100 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 173279 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5469243 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 900004419 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 205972300 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143463 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 633997 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".




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