Provider Demographics
NPI:1124091541
Name:VAN RYN, JACQUES S (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUES
Middle Name:S
Last Name:VAN RYN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11125 DUNN RD STE 301
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6132
Mailing Address - Country:US
Mailing Address - Phone:314-953-8250
Mailing Address - Fax:314-953-8255
Practice Address - Street 1:11125 DUNN RD STE 301
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6132
Practice Address - Country:US
Practice Address - Phone:314-953-8250
Practice Address - Fax:314-953-8255
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4G45207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000000603706OtherBLUE CROSS BLUE SHIELD
MO116020001OtherMEDICARE
MO475415OtherGROUP HEALTH PLAN
MO4048872OtherAETNA
MOP00727699OtherMEDICARE RAILROAD
MO101252OtherHEALTHLINK
MO475415OtherGROUP HEALTH PLAN
MO116020001OtherMEDICARE