Provider Demographics
NPI:1194704833
Name:WAYNE, SHERWYN JORDAN (MD)
Entity type:Individual
Prefix:DR
First Name:SHERWYN
Middle Name:JORDAN
Last Name:WAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:800 S HANLEY RD
Mailing Address - Street 2:#7D
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2687
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 S KIRKWOOD RD
Practice Address - Street 2:SUITE 120
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-7254
Practice Address - Country:US
Practice Address - Phone:314-966-8887
Practice Address - Fax:314-966-3869
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR2534207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4486219OtherAETNA
MOA12955OtherMERCY #80
MO17900OtherBLUE CROSS BLUE SHIELD
MO101316OtherHEALTHLINK
MO49824OtherGHP
MO1495881002OtherCIGNA
MO009032OtherEXCLUSIVE CHOICE
MO0900078OtherUNITED HEALTH CARE
MO49824OtherGHP