Provider Demographics
NPI:1033122676
Name:LI, JASON J (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:J
Last Name:LI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3015 N BALLAS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2329
Mailing Address - Country:US
Mailing Address - Phone:314-996-5169
Mailing Address - Fax:314-996-5390
Practice Address - Street 1:3015 N BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2329
Practice Address - Country:US
Practice Address - Phone:314-996-5169
Practice Address - Fax:314-996-5390
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2021-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2004001650207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH78310Medicare UPIN
P00185379Medicare PIN