Provider Demographics
NPI:1487737615
Name:MCDONALD, JAY R (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:R
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8051
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-289-7064
Mailing Address - Fax:314-289-7604
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-289-7064
Practice Address - Fax:314-289-7604
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2006034063207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204025704Medicaid
MO204025704Medicaid
I68612Medicare UPIN
962710183Medicare PIN
MO204025704Medicaid