Provider Demographics
NPI:1992813745
Name:ELLISON, JAMES (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:ELLISON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:222 S WOODS MILL RD
Mailing Address - Street 2:SUITE 310N
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3625
Mailing Address - Country:US
Mailing Address - Phone:314-576-6700
Mailing Address - Fax:314-576-6520
Practice Address - Street 1:222 S WOODS MILL RD STE 500N
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3640
Practice Address - Country:US
Practice Address - Phone:314-205-6699
Practice Address - Fax:314-590-5923
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2022-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR9C35207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA01748Medicare UPIN
MO935244700Medicare PIN
MO935244700Medicare PIN