Provider Demographics
NPI:1174504146
Name:EBEL, JAMES (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:EBEL
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:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-843-7333
Mailing Address - Fax:314-843-9946
Practice Address - Street 1:5034 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3418
Practice Address - Country:US
Practice Address - Phone:314-843-7333
Practice Address - Fax:314-843-9946
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2D30207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO27001OtherBCBS
MO000000010004OtherESSENCE
MO0400353OtherUHC
MO4361900OtherAETNA
MO127471OtherGHP
MOA09953OtherMERCY
MO101944OtherHEALTHLINK
MOA09953Medicare UPIN
MO4361900OtherAETNA
MO110114077Medicare PIN