Provider Demographics
NPI:1407957301
Name:THOMAS, JEAN ALFRED SR (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:ALFRED
Last Name:THOMAS
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1031 BELLEVUE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1818
Mailing Address - Country:US
Mailing Address - Phone:314-644-4555
Mailing Address - Fax:314-644-4255
Practice Address - Street 1:6125 CLAYTON AVE
Practice Address - Street 2:SUITE 122
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139
Practice Address - Country:US
Practice Address - Phone:314-644-4555
Practice Address - Fax:314-644-4255
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-07-13
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Provider Licenses
StateLicense IDTaxonomies
MOR8402207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201437209Medicaid
MO201437209Medicaid
A09944Medicare UPIN