Provider Demographics
NPI:1063431526
Name:SAFFA, JAMES DENNIS (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DENNIS
Last Name:SAFFA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12855 N 40 DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8657
Mailing Address - Country:US
Mailing Address - Phone:314-432-4415
Mailing Address - Fax:
Practice Address - Street 1:12855 N 40 DR
Practice Address - Street 2:SUITE 280
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8657
Practice Address - Country:US
Practice Address - Phone:314-432-4415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6917207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00608374OtherRAILROAD MEDICARE
MOP01135376OtherRAILROAD MEDICARE
129430008Medicare PIN
MOA13641Medicare UPIN
P00608374OtherRAILROAD MEDICARE
MOP01135376OtherRAILROAD MEDICARE