Provider Demographics
NPI:1134120447
Name:BROWDY, JASON A (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:BROWDY
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 1:8225 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1107
Mailing Address - Country:US
Mailing Address - Phone:314-721-7325
Mailing Address - Fax:314-721-1157
Practice Address - Street 1:633 EMERSON RD STE 100
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6739
Practice Address - Country:US
Practice Address - Phone:314-991-2150
Practice Address - Fax:314-991-2149
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.117297207X00000X
MO2004002148207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO921003387Medicare PIN
MO4208030001Medicare NSC
ILK46199Medicare PIN
MOH98817Medicare UPIN
IL4208030001Medicare NSC
ILK51408Medicare PIN