Provider Demographics
NPI:1134108830
Name:DOLL, JAMES THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:THOMAS
Last Name:DOLL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:307 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-3629
Mailing Address - Country:US
Mailing Address - Phone:314-991-4344
Mailing Address - Fax:314-991-4345
Practice Address - Street 1:633 EMERSON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6739
Practice Address - Country:US
Practice Address - Phone:314-991-4344
Practice Address - Fax:314-991-4345
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000160486208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO179266OtherBLUE CROSS BLUE SHIELD
MO7348439OtherAETNA
MO9949640001OtherCIGNA
MOH78278OtherMERCY #80
MO48117OtherEXCLUSIVE CHOICE
MS614098OtherHEALTHLINK
MO168382OtherGHP
MO2300376OtherUNITHED HEALTH CARE
MOH78278OtherMERCY #80
MOH78278Medicare UPIN